Decreased use of insulin and sulfonylureas seen postintervention
By Lori Solomon HealthDay Reporter
WEDNESDAY, Oct. 11, 2023 (HealthDay News) — In a population of at-risk older patients, the use of a clinical decision support tool and shared decision-making can reduce the risk for hypoglycemia by nearly half, according to a study published online Sept. 21 in the Journal of the American Geriatrics Society.
Deborah A. Koehn, M.D., from the Virginia Commonwealth University Stony Point Women’s Health in Richmond, and colleagues assessed the effectiveness of a clinical decision support tool and shared decision-making in decreasing the number of patients at risk for hypoglycemia and reducing the impact of nonsevere hypoglycemic events. The analysis included 94 patients (aged 65 years and older) seen at five sites of a primary care practice and at risk for treatment-related hypoglycemia.
The researchers found that 94 percent of patients set an individualized hemoglobin A1c (HbA1c) goal at either the baseline or first follow-up visit. Postintervention implementation, insulin or sulfonylurea use was decreased or eliminated in 20 percent. In more than half of patients (53 percent), HbA1c level before and after goal setting was obtained. Among these patients, mean HbA1c significantly increased 0.53 percent, and the number of patients at risk significantly decreased by nearly half (46 percent). For both the total score and each functional domain of the Treatment Related Impact Measure-Hypoglycemic Events patient-reported tool, there were statistically significant reductions in the impact of hypoglycemia during daily activities.
“Because this intervention was so successful, we hope that our clinical decision support tool could be adopted for use in other primary care settings to lower the risk of hypoglycemia and improve the overall well-being of older adults with diabetes,” coauthor Jeffrey B. Boord, M.D., M.P.H., from Parkview Health System in Fort Wayne, Indiana, said in a statement.
Several authors disclosed financial ties to the pharmaceutical industry; the study was funded by Merck, Lilly, Novo Nordisk, Sanofi, and Abbott.
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