Weaning or reducing diabetes medications in elderly nursing home residents is possible and may reduce the risk of hypoglycemic events that can cause cognitive impairment, cardiac arrhythmias, and even death, a small Swedish study has concluded.
Blood glucose remained stable in the intervention patients by 3 and 6 months. Glucose levels also decreased slightly in patients in a comparator group that continued antidiabetes medications during the study period, Dr. Peter Sjoblom of the Soderkoping (Sweden) Primary Health Care Center and colleagues reported.
They noted the effect of diabetes medication continuation, or withdrawal/reduction in 98 patients (mean age 84 years). Patients with hemoglobin A1c (HbA1c) levels at 6% or higher at baseline (66) stayed on their medication, whereas those with HbA1c levels below 6% (32) were placed in the intervention group. Of these, 10 took oral antidiabetic drugs, 17 needed insulin injections, and 5 were on a combination regimen (Diab. Res. Clin. Pract. 2008;82:197–202).
Before intervention, the frequency of hypoglycemia was assessed by measuring the interventions groups' glucose levels 4 times each day for 3 days. There were 31 episodes of hypoglycemia (mean blood glucose level of 72 mg/dL or lower), of which about half (17) were at night.
Frequency varied with the antidiabetic regimen: 40% of patients on oral drugs alone had at least one hypoglycemic event, as did 75% of those on injected insulin and 100% of those on combination regimens.
After the baseline glucose measurements, oral drugs were withdrawn, as was insulin in patients taking 20 U/day or less. Insulin was cut by half in those taking more than 20 U/day.
At 3 months, 24 patients (76%) had been successfully weaned from their medication. Hyperglycemia (plasma glucose of at least 16 mmol/L) occurred in four patients; their medications were restored. Two patients were withdrawn from the trial due to relatives' concern, and two died from causes unrelated to diabetes.
The study was funded by local and regional governmental grants.
The authors said they had no conflicts of interest.