Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD.
Diabetes Care. 2023 Jun 1;46(6):1164-1168. doi: 10.2337/dc22-2146.
To determine physicians' approach to deintensifying (reducing/stopping) or switching hypoglycemia-causing medications for older adults with type 2 diabetes.
In this national survey, U.S. physicians in general medicine, geriatrics, or endocrinology reported changes they would make to hypoglycemia-causing medications for older adults in three scenarios: good health, HbA1c of 6.3%; complex health, HbA1c of 7.3%; and poor health, HbA1c of 7.7%.
There were 445 eligible respondents (response rate 37.5%). In patient scenarios, 48%, 4%, and 20% of physicians deintensified hypoglycemia-causing medications for patients with good, complex, and poor health, respectively. Overall, 17% of physicians switched medications without significant differences by patient health. One-half of physicians selected HbA1c targets below guideline recommendations for older adults with complex or poor health.
Most U.S. physicians would not deintensify or switch hypoglycemia-causing medications within guideline-recommended HbA1c targets. Physician preference for lower HbA1c targets than guidelines needs to be addressed to optimize deintensification decisions.
确定医生在为患有 2 型糖尿病的老年患者减轻（减少/停止）或更换导致低血糖的药物方面的方法。
在这项全国性调查中，普通内科、老年病学或内分泌学的美国医生报告了他们将在三种情况下对导致老年患者低血糖的药物进行的更改：身体健康、HbA1c 为 6.3%；复杂健康状况、HbA1c 为 7.3%；以及健康状况不佳、HbA1c 为 7.7%。
共有 445 名合格受访者（回应率为 37.5%）。在患者情况下，分别有 48%、4%和 20%的医生为身体健康、复杂健康和健康状况不佳的患者减轻了导致低血糖的药物剂量。总体而言，17%的医生在不考虑患者健康状况的情况下更换了药物。有一半的医生选择了低于指南为复杂或健康状况不佳的老年患者推荐的 HbA1c 目标。
大多数美国医生不会在符合指南建议的 HbA1c 目标范围内减轻或更换导致低血糖的药物。需要解决医生对低于指南的 HbA1c 目标的偏好，以优化减药决策。
