Can diabetes medication be reduced in elderly patients? : An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control

Aim: To explore the feasibility of withdrawal of diabetes medication in elderly patients with HbA1c £ 6.0%. Methods: HbA1c was measured in 98 patients with known diabetes in 17 nursing homes in Sweden. 32 subjects with HbA1c £ 6.0% participated in the drug withdrawal study. After measuring plasma glucose on three consecutive days, diabetes drugs were reduced, i.e. complete withdrawal of oral anti-diabetic drugs (OADs), complete insulin withdrawal when doses were £ 20 units/day and reduced by half in patients on more than 20 units/day. Results: We identified 31 episodes of plasma glucose £ 4.4 mmol/l, most of them nocturnal (n=17). Mean HbA1c was 5.2 % ± 0.4 compared to 7.1 % ± 1.6 in the non-intervention group. Three months after the diabetes drug discontinuation, 24 patients (75%) remained in the intervention group and mean HbA1c was then 5.8 %. ± 0.9. Six months after baseline investigation mean HbA1c in the intervention group was 5.8 % ± 1.1 compared with 6.6 % ± 1.4 in the non-intervention group. Conclusions: Hypoglycaemic events are common among elderly patients with type 2 diabetes. The withdrawal of diabetes medication in elderly with tight glycaemic control is safe and may decrease the risk for hypoglycaemia.Original Publication: Peter Sjöblom, Anders Tengblad, Ulla-Britt Löfgren, Christina Lannering, Niklas Anderberg, Ulf Rosenqvist, Sigvard Mölstad and Carl J Östgren, Can diabetes medication be reduced in elderly patients?: An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control, 2008, Diabetes Research and Clinical Practice, (82), 2, 197-202. http://dx.doi.org/10.1016/j.diabres.2008.08.014 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/