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Potential Overtreatment and Overtesting Among Older Adults With Type 2 Diabetes Across Canada: An Observational, Retrospective Cohort Study

Published:March 06, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.02.010

      Abstract

      Objective

      Our aim in this study was to assess potential overtreatment and overtesting among older adults with type 2 diabetes across Canada.

      Methods

      An observational, population-based cohort study was conducted using data available through the Canadian Primary Care Sentinel Surveillance Network. All patients included in the study were seen by a primary care provider between 2010 and 2017, ≥65 years with type 2 diabetes and had at least one glycated hemoglobin (A1C) measurement. Potential overtreatment was defined as an index A1C of <7% and being prescribed antidiabetes medications other than metformin within 1 year of the index A1C. Testing ≥3 times/year in patients with A1C <7% was considered potential overtesting. Analyses were performed/compared within 2 cross-sectional cohorts (2012 and 2016). A subcohort analysis was performed on those with advanced age and dementia.

      Results

      An overall cohort of 41,032 patients (mean age, 76.6 years) was identified. Proportions of potential overtreatment were 7.0% (2012) and 6.9% (2016) (difference in rate in %: 0.1; 95% confidence interval [CI], −0.32 to 0.52]). Overall, 19.2% (2012) and 19.0% (2016) of patients were potentially overtested (difference in rate in %: 0.2; 95% CI, −0.45 to 0.85), whereas 2.4% (2012) and 2.3% (2016) were potentially undertested (difference in rate in %: 0.1; 95% CI, −0.15 to 0.35). Among patients with dementia and advanced age, proportions of patients potentially overtreated were 14.5% and 12.1%, and those overtested were 29.2% and 25.0% in 2012 and 2016, respectively.

      Conclusions

      Potential overtreatment and overtesting exists among older adults with diabetes in Canadian primary care practices with minimal change over time. Higher proportions of potentially unnecessary care were observed in those with advanced age and dementia. Our study highlights an opportunity for primary care clinicians to improve testing and treatment practices considering the individual patient, context and potential for net benefit.

      Résumé

      Objectifs

      Dans la présente étude, notre objectif était d’évaluer le surtraitement et la surévaluation potentiels chez les personnes âgées atteintes du diabète de type 2 du Canada.

      Méthodes

      Nous avons réalisé une étude observationnelle en population générale à partir des données disponibles dans le Réseau canadien de surveillance sentinelle de soins primaires. Tous les patients de l’étude ont rencontré un prestataire de soins primaires entre 2010 et 2017, étaient des diabétiques de type 2 de ≥ 65 ans et avaient au moins une mesure de l’hémoglobine glyquée (A1c). On a défini que le surtraitement potentiel était le fait d’avoir une A1c de référence de < 7 % et de recevoir des ordonnances de médicaments contre le diabète autres que la metformine dans l’année de l’A1c de référence. Nous avons considéré les patients qui avaient une A1C < 7 % et qui étaient évalués ≥3 fois/année comme étant en situation de surévaluation potentielle. Les analyses ont été réalisées/comparées entre 2 cohortes transversales (2012 et 2016). Nous avons réalisé une analyse auprès d’une sous-cohorte de patients qui avaient un âge avancé et une démence.

      Résultats

      Nous avons recensé une cohorte globale de 41 032 patients (âge moyen, 76,6 ans). Les pourcentages de surtraitement potentiel étaient de 7,0 % (2012) et de 6,9 % (2016) (0,1; intervalle de confiance [IC] à 95 %, de −0,32 à 0,52]). Dans l’ensemble, 19,2 % (2012) et 19,0 % (2016) des patients étaient potentiellement en situation de surévaluation (0,2; IC à 95 %, de −0,45 à 0,85), tandis que 2,4 % (2012) et 2,3 % (2016) étaient potentiellement en situation de sous-évaluation (0,1; IC à 95 %, de −0,15 à 0,35). Chez les patients qui avaient une démence et un âge avancé, les pourcentages de patients potentiellement en situation de surtraitement étaient de 14,5 % et de 12,1 %, et ceux qui étaient en situation de surévaluation étaient de 29,2 % et de 25,0 % en 2012 et 2016, et ce respectivement.

      Conclusions

      Dans la pratique canadienne en soins primaires, les personnes âgées diabétiques sont en situation de surtraitement et de surévaluation potentiels. De plus, peu de changements ont été observés dans le temps. Les pourcentages plus élevés de soins potentiellement non nécessaires étaient observés chez ceux qui avaient un âge avancé et une démence. Notre étude présente la possibilité aux cliniciens en soins primaires d’améliorer les pratiques d’évaluation et de traitement qui considèrent le patient individuellement, le contexte et le potentiel d’un avantage net.

      Keywords

      Mots clés

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