Evidence map›Paper›PMID 32303827›Full record

SynthesisZeitschrift fur Gerontologie und Geriatrie2021

Evidence gap on antihyperglycemic pharmacotherapy in frail older adults : A systematic review.

Claudia Bollig, Gabriel Torbahn, Jürgen Bauer, Simone Brefka, Dhayana Dallmeier, Michael Denkinger, Annette Eidam, Stefan Klöppel, Andrej Zeyfang, Sebastian Voigt-Radloff and 1 more

Open access · hybridAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Zeitschrift fur Gerontologie und Geriatrie, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
2.0field-weighted citation impact, top 13% 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

5 citing papers in PubMed, 17 citations in OpenAlex.

  1. Trial
  2. Review
  3. Review
  4. Article
  5. Review
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

11 authors at 5 institutions in 3 countries.

Claudia BolligInstitute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany. bollig@ifem.uni-freiburg.de.
Gabriel TorbahnInstitute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
Jürgen BauerCenter for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany.
Simone BrefkaAgaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany.
Dhayana DallmeierAgaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany.
Michael DenkingerAgaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany.
Annette EidamCenter for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany.
Stefan KlöppelUniversity Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Andrej ZeyfangDepartment of Epidemiology, University of Ulm, Ulm, Germany.
Sebastian Voigt-RadloffInstitute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany. sebastian.voigt@uniklinik-freiburg.de.
MedQoL-Group (Medication and Quality of Life in frail older persons)
University of Freiburg · DEAgaplesion Bethesda Klinik · DEHeidelberg University · DEUniversity of Bern · CHUniversity Medical Center Freiburg · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough antihyperglycemic pharmacotherapy in frail older adults with type 2 diabetes mellitus (T2DM) is challenging, recommendations from international guidelines are mainly based on indirect evidence from trials not including frail participants.

objectiveThis systematic review investigated the effectiveness and safety of pharmacotherapy in frail older adults with T2DM. MATERIAL AND

methodsRandomized (RCT) and non-randomized prospective clinical trials (non-RCT) were searched in three electronic databases (Medline, Embase, Central) up to October 2018. Trials in older adults with T2DM who were assessed as significantly or severely impaired by defined cut-off scores of assessment instruments on frailty, activities of daily living or physical functional impairment were included.

resultsTwo reviewers independently screened 17,391 references for inclusion and assessed risk of bias with ROBINS‑I. Five non-RCTs and no RCT were identified. Treatment of T2DM without insulin compared to insulin could be associated with increased improvement in cardiac functions in patients with cardiac resynchronization therapy and with decreased falls in frail older women. While better glycemic control with low variability and low HbA1c (hemoglobin A1c) values (<7%) was associated with better maintenance of physical function in community-dwelling older persons, higher HbA1c values (8-8.9%) were associated with a reduction in the composite outcome of death or functional decline in community-dwelling diabetic older adults with need for skilled assistance. Due to serious risk of bias in all studies, results should be considered with caution.

conclusionWell-designed, large-scale RCTs including this important group of patients are required to assess the effectiveness and safety of pharmacotherapy and HbA1c targets.

Indexed as

Diabetes Mellitus, Type 2Frail ElderlyActivities of Daily LivingAgedAged, 80 and overFemaleHumansHypoglycemic AgentsProspective StudiesHypoglycemic AgentsAgedDiabetes mellitusDrug therapyFrailtySystematic review

Identifiers

PMID32303827
PMCPMC8096761
OpenAlexW3016609067

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.