Evidence map›Paper›PMID 28905179›Full record

ArticleJournal of general internal medicine2018

Overtreatment and Deintensification of Diabetic Therapy among Medicare Beneficiaries.

Matthew L Maciejewski, Xiaojuan Mi, Jeremy Sussman, Melissa Greiner, Lesley H Curtis, Judy Ng, Samuel C Haffer, Eve A Kerr

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of general internal medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed
–field-weighted citation impact
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

20 citing papers in PubMed.

  1. Trial
  2. Trial
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  4. Therapeutic Inertia in the Management of Type 2 Diabetes: A Narrative Review.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2024
    Review
  5. Article
  6. Article
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  9. Article
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  15. Simplifying Complex Insulin Regimens While Preserving Good Glycemic Control in Type 2 Diabetes.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2019
    Article
  16. Review
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Matthew L MaciejewskiCenter for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA. mlm34@duke.edu.
Xiaojuan MiDuke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Jeremy SussmanCenter for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA.
Melissa GreinerDuke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Lesley H CurtisDivision of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, 27705, USA.
Judy NgNational Committee for Quality Assurance, Washington, DC, USA.
Samuel C HafferOffice of Minority Health, U.S. Centers for Medicare & Medicaid Services, Baltimore, MD, USA.
Eve A KerrCenter for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDeintensification of diabetic therapy is often clinically appropriate for older adults, because the benefit of aggressive diabetes treatment declines with age, while the risks increase.

objectiveWe examined rates of overtreatment and deintensification of therapy for older adults with diabetes, and whether these rates differed by medical, demographic, and socioeconomic characteristics. DESIGN, SUBJECTS, AND MAIN MEASURES: We analyzed Medicare claims data from 10 states, linked to outpatient laboratory values to identify patients potentially overtreated for diabetes (HbA1c < 6.5% with fills for any diabetes medications beyond metformin, 1/1/2011-6/30/2011). We examined characteristics associated with deintensification for potentially overtreated diabetic patients. We used multinomial logistic regression to examine whether patient characteristics associated with overtreatment of diabetes differed from those associated with undertreatment (i.e. HbA1c > 9.0%). KEY

resultsOf 78,792 Medicare recipients with diabetes, 8560 (10.9%) were potentially overtreated. Overtreatment of diabetes was more common among those who were over 75 years of age and enrolled in Medicaid (p < 0.001), and was less common among Hispanics (p = 0.009). Therapy was deintensified for 14% of overtreated diabetics. Appropriate deintensification of diabetic therapy was more common for patients with six or more chronic conditions, more outpatient visits, or living in urban areas; deintensification was less common for those over age 75. Only 6.9% of Medicare recipients with diabetes were potentially undertreated. Variables associated with overtreatment of diabetes differed from those associated with undertreatment.

conclusionsMedicare recipients are more frequently overtreated than undertreated for diabetes. Medicare recipients who are overtreated for diabetes rarely have their regimens deintensified.

Indexed as

AgedAged, 80 and overBlood GlucoseCohort StudiesDiabetes MellitusFemaleHumansHypoglycemic AgentsMaleMedical OveruseMedicareUnited StatesBlood GlucoseHypoglycemic AgentsbeneficiarydeintensificationdiabetesMedicarepotential overtreatment

Identifiers

PMID28905179
PMCPMC5756160

What OpenQuestion holds

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Registered trials

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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.