Evidence map›Paper›PMID 38220558›Full record

ArticlePrimary care diabetes2024

Deintensification of potentially inappropriate medications amongst older frail people with type 2 diabetes: Protocol for a cluster randomised controlled trial (D-MED study).

Lauren O'Mahoney, Patrick Highton, Ruksar Abdala, Helen Dallosso, Clare L Gillies, Seema Ragha, Fiona Munday, John Robinson, Andrew Marshall, James P Sheppard and 2 more

Open access · hybridAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in Primary care diabetes, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.2field-weighted citation impact, top 23% 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

2 citing papers in PubMed, 3 citations in OpenAlex.

  1. Article
  2. 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

12 authors at 4 institutions in 1 country.

Lauren O'MahoneyDiabetes Research Centre, University of Leicester, Leicester, UK; National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, UK.
Patrick HightonDiabetes Research Centre, University of Leicester, Leicester, UK; National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, UK. Electronic address: ph204@le.ac.uk.
Ruksar AbdalaDiabetes Research Centre, University of Leicester, Leicester, UK; National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, UK.
Helen DallossoUniversity Hospitals of Leicester NHS Trust, Leicester Diabetes Centre, Leicester, UK.
Clare L GilliesLeicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
Seema RaghaLeicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
Fiona MundayDiabetes Research Centre, University of Leicester, Leicester, UK.
John RobinsonPrimary Care Information Service, University of Nottingham, Nottingham, UK.
Andrew MarshallPrimary Care Information Service, University of Nottingham, Nottingham, UK.
James P SheppardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Kamlesh KhuntiDiabetes Research Centre, University of Leicester, Leicester, UK; National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, UK.
Samuel SeiduDiabetes Research Centre, University of Leicester, Leicester, UK.
University of Leicester · GBUniversity of Nottingham · GBUniversity Hospitals of Leicester NHS Trust · GBUniversity of Oxford · GB

Funding

British Heart Foundation PG/21/10341Wellcome Trust 211182Wellcome Trust 211182/Z/18/Z
6 · The paper itself

Abstract

aimsAmongst elderly people with type 2 diabetes (T2D) over prescribing can result in emergency ambulance call-outs, falls and fractures and increased mortality, particularly in frail patients. Current clinical guidelines, however, remain focused on medication intensification rather than deintensification where appropriate. This study aims to evaluate the effectiveness of an electronic decision-support system and training for the deintensification of potentially inappropriate medications amongst older frail people with T2D, when compared to 'usual' care at 12-months.

methodsThis study is an open-label, multi-site, two-armed pragmatic cluster-randomised trial. GP practices randomised to the 'enhanced care' group have an electronic decision support system installed and receive training on the tool and de-intensification of diabetes medications. The system flags eligible patients for possible deintensification of diabetes medications, linking the health care professional to a clinical algorithm. The primary outcome will be the number of patients at 12-months who have had potentially inappropriate diabetes medications de-intensified.

resultsStudy recruitment commenced in June 2022. Data collection commenced in January 2023. Baseline data have been extracted from 40 practices (3145 patients).

conclusionsDigital technology, involving computer decision systems, may have the potential to reduce inappropriate medications and aid the process of de-intensification.

trial registrationInternational Standard Randomised Controlled Trial Number: ISRCTN53221378. Available at: https://www.isrctn.com/ISRCTN53221378.

Indexed as

Diabetes Mellitus, Type 2Potentially Inappropriate Medication ListAgedData CollectionFrail ElderlyHumansInappropriate PrescribingPragmatic Clinical Trials as TopicRandomized Controlled Trials as TopicDe-intensifying medicationsOvertreatmentPrimary health careType 2 diabetes

Identifiers

PMID38220558
PMCPMC7618157
OpenAlexW4390889519

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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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.