In:
Diabetes, American Diabetes Association, Vol. 72, No. Supplement_1 ( 2023-06-20)
Abstract:
Background: The ADA recommends treatment de-intensification be considered in older patients with poor health, on complex regimens, or experiencing side effects. We examined factors associated with older patients’ willingness to de-intensify treatment. Methods: Cross-sectional analysis of Diabetes Preferences and Self-Care Survey responses and EHR data in adults with type 2 diabetes from Kaiser Permanente Northern California. We calculated proportions of patients who responded to the survey question “I would be willing to take less medication for my diabetes” as willing, neutral, or unwilling. Willingness was contrasted across demographic, clinical, and health status factors. Results: Analysis included 1,337 adults prescribed glucose-lowering medications (age 74.2 ± 6.0 years, 44% women, 54.4% non-Hispanic white). The proportions of willing, neutral, and unwilling to de-intensify treatment were 51.2%, 27.3%, and 21.5%, respectively. Willingness to de-intensify varied by age (p & lt;0.001) with 54.2% of younger adults (age 65-74) willing to de-intensify compared to 38.5% of older adults (age 85+). Willingness varied by duration of diabetes (p & lt;0.001) with 61.0% of adults with diabetes for 0-4 years willing to de-intensify compared to 44.2% of adults with diabetes for longer duration ( & gt;15 years). Willingness among those with good, intermediate, or poor health status (as defined by the ADA) was 54.2% vs. 47.5% vs. 55.1%, respectively. Individuals with an A1c greater than 9% were more willing to de-intensify treatment compared to individuals with A1c of 7%-9%, or & lt;7%, (57% vs 51% vs 50%, p & lt;0.001). Willingness to de-intensify decreased as number of medications increased (p & lt;0.001) and little difference was noted in willingness among patients by insulin use or hypoglycemia history. Discussion: Patterns of patient willingness to de-intensify treatment are misaligned with clinical guideline recommendations and highlight the influence of patient experience living with diabetes over time. Disclosure S.Haider: None. M.M.Parker: Research Support; Dexcom, Inc. E.Huang: Advisory Panel; Twin Health, Stock/Shareholder; AbbVie Inc., Cardinal Health, Amgen Inc. R.W.Grant: None. H.H.Moffet: Research Support; Dexcom, Inc. N.Laiteerapong: None. J.Liu: None. K.J.Lipska: Other Relationship; UpToDate. A.J.Karter: None. Funding National Institute on Aging (5R01AG063391)
Type of Medium:
Online Resource
ISSN:
0012-1797
Language:
English
Publisher:
American Diabetes Association
Publication Date:
2023
detail.hit.zdb_id:
1501252-9
