Evidence map›Paper›PMID 28416531›Full record

ArticleCirculation. Cardiovascular quality and outcomes2017

Treatment Deintensification Is Uncommon in Adults With Type 2 Diabetes Mellitus: A Retrospective Cohort Study.

Finlay A McAlister, Erik Youngson, Dean T Eurich

Open access · bronzeAbstract read
PubMed Publisher
In one paragraph

Article in Circulation. Cardiovascular quality and outcomes, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 1 pooled it
3.2field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.

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  5. Clinical outcomes of insulin deintensification in a real-world primary care setting: A retrospective observational study.Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia · 2026
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  12. Expert Panel Guidance and Narrative Review of Treatment Simplification of Complex Insulin Regimens to Improve Outcomes in Type 2 Diabetes.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 1 institution in 1 country.

Finlay A McAlisterFrom the Division of General Internal Medicine (F.A.M.), the Patient Health Outcomes Research and Clinical Effectiveness Unit (F.A.M., E.Y.), and School of Public Health and Alliance for Canadian Health Outcomes Research in Diabetes (D.T.E.), University of Alberta, Edmonton, Canada. Finlay.McAlister@ualberta.ca.
Erik YoungsonFrom the Division of General Internal Medicine (F.A.M.), the Patient Health Outcomes Research and Clinical Effectiveness Unit (F.A.M., E.Y.), and School of Public Health and Alliance for Canadian Health Outcomes Research in Diabetes (D.T.E.), University of Alberta, Edmonton, Canada.
Dean T EurichFrom the Division of General Internal Medicine (F.A.M.), the Patient Health Outcomes Research and Clinical Effectiveness Unit (F.A.M., E.Y.), and School of Public Health and Alliance for Canadian Health Outcomes Research in Diabetes (D.T.E.), University of Alberta, Edmonton, Canada.
Alliance for Canadian Health Outcomes Research in Diabetes · CA

Funding

CIHR MOP 126093
6 · The paper itself

Abstract

backgroundWhether treatment deintensification in Americans with diabetes mellitus varies by glycemic control, health status, and calendar year (before/after February 2008 when safety concerns about intensive glucose control were reported in the ACCORD trial [Action to Control Cardiovascular Risk in Diabetes]) is unclear. METHODS AND

resultsWe defined deintensification as discontinuation or dosage decrease of at least 1 glycemic medication without addition of, or uptitration of, another agent in the 120 days after the index glycosylated hemoglobin (HbA1C) measurement. Of 99 694 individuals (mean age 54 years) in this retrospective cohort study being actively treated for new diabetes mellitus (50% 1 drug, 33% 2 drugs, and 17% ≥3 drugs), 12 921 (13.0%) had HbA1C <6% after 1 year, 19 670 (19.7%) had HbA1C 6.0% to 6.4%, 35 012 (35.1%) had HbA1C 6.5% to 7.5%, and 32 091 (32.2%) had HbA1C >7.5%. Glycemic therapy was deintensified in 18.3% of patients (21.2% of frail patients, 19.4% of those with multiple comorbidities, and 17.7% of otherwise healthy patients) with no gradient across glycemia levels (20.6% of those with HbA1C<6%, 17.3% of those with HbA1C 6.0%-6.4%, 17.7% of those with HbA1C 6.5%-7.5%, and 18.6% of those with HbA1C>7.5%). Similar proportions were seen even after exclusion of 26 985 patients being treated with metformin monotherapy: 23.3%, 20.4%, 20.3%, and 20% across the HbA1C strata. Therapy was deintensified in 22.5% of patients with index HbA1C <6.0% before February 2008 compared with 19.5% after (

conclusionsAmong frail patients or those with multiple comorbidities, over three quarters with low HbA1C did not have their glycemic therapy deintensified, even after safety concerns were raised in the ACCORD trial.

Indexed as

AdultBiomarkersBlood GlucoseComorbidityDiabetes Mellitus, Type 2Drug Therapy, CombinationFemaleGlycated HemoglobinHealth StatusHumansHypoglycemic AgentsMaleMiddle AgedPatient SafetyPractice Patterns, Physicians'Retrospective StudiesBiomarkersBlood GlucoseGlycated Hemoglobinhemoglobin A1c protein, humanHypoglycemic Agentscomorbiditydiabetes mellitushealth statusheart failuremetformin

Identifiers

PMID28416531
OpenAlexW2606759177

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.