A retrospective evaluation of prescribing practices related to intensity of glycemic control among older adults with type-2 diabetes across Canada
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Date
2019-08-29
Authors
Gudi, Sai Krishna
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Abstract
Background: Diabetes is highly prevalent among the elderly population. Optimal glucose management in this cohort remains ill-defined with high-quality evidence lacking and hypoglycemia risk a significant concern. The extent of overtreatment in Canada is not clearly established.
Methods: This retrospective observational cohort study was conducted using primary care data between 2010-2017 from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) to assess proportions of over-treatment among patients with type-2 diabetes across Canada (phase-I). A further detailed analysis was performed using administrative population-based data of the Manitoba Centre for Health Policy (MCHP) to assess over-treatment in Manitoba (phase-II). Number of overall medications and annual HbA1c testing frequency were also assessed as a measure of burden. SAS® statistical software was used for the analyses.
Results: Using CPCSSN data, overall rates of over-treatment were 7.0% in 2012 and 6.9% in 2016, while rates were significantly higher (20.4% (2012), 21.5% (2016)) using MCHP data. A considerable proportion with poorly-controlled diabetes ((41.9% (2012), 35.8% (2016) in phase-I) and (19% in 2012 & 10.5% in 2016 in phase-II)) were prescribed no medications, indicating under-treatment. The mean number of overall medications prescribed per patient was 4.4 (SD ± 4.5) in 2012 and 5.1 (SD ± 4.9) in 2016, and 39% and 41% were prescribed 5 or more medications in 2012 and 2016, respectively. Approximately 19% of patients were potentially over-tested, while just over 2% were potentially under-tested. Rates of over-treatment and over-testing were higher in those with advanced age and those with dementia.
Conclusions: Potential over-treatment rates in this Canadian primary care population appeared lower compared to US studies. However, rates were found to be significantly higher in Manitoba using dispensation data compared to provincial & national primary care prescription data, with no evidence of rates decreasing over time. In contrast, there was a considerable proportion of poorly controlled patients who were potentially undertreated. Patients with advanced age and dementia appear to be over-treated and tested. These findings indicate a need for individually tailored personalized diabetes management in Canada.
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Keywords
Diabetes, Older Adults, Over-Treatment, Glycemic Control, Manitoba, Canada, CPCSSN, Prescribing Practices