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
of age 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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Article Info
Publication History
Published online: March 06, 2022
Accepted:
February 24,
2022
Received in revised form:
December 23,
2021
Received:
June 30,
2021
Identification
Copyright
© 2022 Canadian Diabetes Association.
