Observational studyJournal of managed care & specialty pharmacy2015
A Real-World Observational Study of Time to Treatment Intensification Among Elderly Patients with Inadequately Controlled Type 2 Diabetes Mellitus.
Observational study in Journal of managed care & specialty pharmacy, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.
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Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it, 19 citations in OpenAlex.
- Prevalence of polypharmacy among older adults with diabetes: A systematic review and Meta-Analysis.Aging clinical and experimental research · 2025Pooled it
- Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review.Diabetes, obesity & metabolism · 2018 · on this mapPooled it
- Efficacy and safety of lixisenatide as add-on therapy to basal insulin in older adults with type 2 diabetes in the GetGoal-O Study.Journal of diabetes · 2019Trial
- Beta cells to brain cells: The pivotal role of insulin and glucose metabolism in Alzheimer's disease.Neuroprotection (Chichester, England) · 2025Review
- A machine learning model to predict therapeutic inertia in type 2 diabetes using electronic health record data.Journal of endocrinological investigation · 2024Article
- The impact of phenotype, ethnicity and genotype on progression of type 2 diabetes mellitus.Endocrinology, diabetes & metabolism · 2020Review
- Clinical Inertia in Poorly Controlled Type 2 Diabetes Mellitus Patients with Obesity: An Observational Retrospective Study.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2020Article
- Treatment Intensification in Type 2 Diabetes: A Real-World Study of 2-OAD Regimens, GLP-1 RAs, or Basal Insulin.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2018 · on this mapArticle
- Overtreatment and Deintensification of Diabetic Therapy among Medicare Beneficiaries.Journal of general internal medicine · 2018Article
- Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved.BMC health services research · 2017Article
Corrections and comments
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Authors and funding
7 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundAmong elderly patients, the management of type 2 diabetes mellitus (T2DM) is complicated by population heterogeneity and elderly-specific complexities. Few studies have been done to understand treatment intensification among elderly patients failing multiple oral antidiabetic drugs (OADs).
objectiveTo examine the association between time to treatment intensification of T2DM and elderly-specific patient complexities.
methodsIn this observational, retrospective cohort study, elderly (aged ≥ 65 years) Medicare beneficiaries (n = 16,653) with inadequately controlled T2DM (hemoglobin A1c ≥ 8.0% despite 2 OADs) were included. Based on the consensus statement for diabetes care in elderly patients published by the American Diabetes Association and the American Geriatric Society, elderly-specific patient complexities were defined as the presence or absence of 5 geriatric syndromes: cognitive impairment; depression; falls and fall risk; polypharmacy; and urinary incontinence.
resultsOverall, 48.7% of patients received intensified treatment during follow-up, with median time to intensification 18.5 months (95% CI = 17.7-19.3). Median time to treatment intensification was shorter for elderly patients with T2DM with polypharmacy (16.5 months) and falls and fall risk (12.7 months) versus those without polypharmacy (20.4 months) and no fall risk (18.6 months). Elderly patients with urinary incontinence had a longer median time to treatment intensification (18.6 months) versus those without urinary incontinence (14.6 months). The median time to treatment intensification did not significantly differ by the elderly-specific patient complexities that included cognitive impairment and depression. However, after adjusting for demographic, insurance, clinical characteristics, and health care utilization, we found that only polypharmacy was associated with time to treatment intensification (adjusted hazard ratio, 1.10; 95% CI = 1.04-1.15; P = 0.001).
conclusionsLess than half of elderly patients with inadequately controlled T2DM received treatment intensification. Elderly-specific patient complexities were not associated with time to treatment intensification, emphasizing a positive effect of the integrated health care delivery model. Emerging health care delivery models that target integrated care may be crucial in providing appropriate treatment for elderly T2DM patients with complex conditions.
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