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2. De-Intensification Of Blood Glucose Lowering Medication In People Identified As Being Over-Treated: A Mixed Methods Study

Author

Hart, Huberta E, Ditzel, Kim, Rutten, Guy E, de Groot, Esther, Seidu, Samuel, Khunti, Kamlesh, and Vos, Rimke C

Subjects
Elderly, Overtreatment, Patient Preference and Adherence, Health Policy, Insulin therapy, Medicine (miscellaneous), Type 2 diabetes, Hypoglycaemia, Primary care, Pharmacology, Toxicology and Pharmaceutics (miscellaneous), Social Sciences (miscellaneous), Original Research
Abstract

Huberta E Hart,1,2,* Kim Ditzel,1,* Guy E Rutten,1 Esther de Groot,1 Samuel Seidu,3 Kamlesh Khunti,3 Rimke C Vos1,4 1Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands; 2Leidsche Rijn Julius Health Centers, Utrecht, The Netherlands; 3Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; 4Department of Public Health and Primary Care/lumc-Campus the Hague, Leiden University Medical Center, The Hague, The Netherlands*These authors contributed equally to this workCorrespondence: Huberta E HartJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Erasmuslaan 68, Zeist 3707 ZE, The NetherlandsTel +31 6 1695 0844Email h.e.hart@umcutrecht.nlAim: To evaluate if, one year after notification of possible overtreatment, diabetes care providers de-intensified glucose-lowering medications and to gain insight into the opinions and beliefs of both care providers and patients regarding de-intensification.Methods: Mixed methods using routine care data from five health-care centres in the Netherlands. Patient characteristics and medication prescription of patients, previously identified as possibly over-treated, were extracted from patients’ medical records. Opinions of care providers were obtained through interviews. Patients received questionnaires about their diabetes treatment and were asked to participate in focus groups.Results: A total of 64 elderly patients with type 2 diabetes were previously identified as possibly over-treated and included; 57.8% male, median age 75 years (IQR=72–82), median diabetes duration 12 years (IQR=8–18). De-intensification was implemented in more than half (n=36) of them. Care providers preferred person-centred care above just setting general HbA1c target values, considering patient characteristics (such as comorbidity) and patient’s preference. Patients valued glucose levels as most important in determining their treatment. Both patients and care providers felt that de-intensification should occur gradually.Conclusion: Treatment had been de-intensified in more than half of the patients (56.3%). Insight in reasons for not de-intensifying elderly patients is important since treatment for them can be “person-centred care”. De-intensification is an iterative and time-intensive process.Keywords: elderly, overtreatment, hypoglycaemia, insulin therapy, primary care, type 2 diabetes

Published
2019

4. De-Intensification Of Blood Glucose Lowering Medication In People Identified As Being Over-Treated: A Mixed Methods Study

Author

Hart,Huberta E, Ditzel,Kim, Rutten,Guy E, de Groot,Esther, Seidu,Samuel, Khunti,Kamlesh, Vos,Rimke C, Hart,Huberta E, Ditzel,Kim, Rutten,Guy E, de Groot,Esther, Seidu,Samuel, Khunti,Kamlesh, and Vos,Rimke C

Abstract

Huberta E Hart,1,2,* Kim Ditzel,1,* Guy E Rutten,1 Esther de Groot,1 Samuel Seidu,3 Kamlesh Khunti,3 Rimke C Vos1,4 1Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands; 2Leidsche Rijn Julius Health Centers, Utrecht, The Netherlands; 3Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; 4Department of Public Health and Primary Care/lumc-Campus the Hague, Leiden University Medical Center, The Hague, The Netherlands*These authors contributed equally to this workCorrespondence: Huberta E HartJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Erasmuslaan 68, Zeist 3707 ZE, The NetherlandsTel +31 6 1695 0844Email h.e.hart@umcutrecht.nlAim: To evaluate if, one year after notification of possible overtreatment, diabetes care providers de-intensified glucose-lowering medications and to gain insight into the opinions and beliefs of both care providers and patients regarding de-intensification.Methods: Mixed methods using routine care data from five health-care centres in the Netherlands. Patient characteristics and medication prescription of patients, previously identified as possibly over-treated, were extracted from patients’ medical records. Opinions of care providers were obtained through interviews. Patients received questionnaires about their diabetes treatment and were asked to participate in focus groups.Results: A total of 64 elderly patients with type 2 diabetes were previously identified as possibly over-treated and included; 57.8% male, median age 75 years (IQR=72–82), median diabetes duration 12 years (IQR=8–18). De-intensification was implemented in more than half (n=36) of them. Care providers preferred person-centred care above just setting general HbA1c target values, considering patient characteristics (such as comorbidity) and patient’s preference. Patients valued glucos

Published
2019

5. De-intensification of blood glucose lowering medication in people identified as being over-treated: A mixed methods study

Author

Huisartsopleiding, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, HAG Zorginnovatieonderzoek, HAG Diabetes, JC Overig onderzoek, HAG Hart- Vaatziekten, Other research (not in main researchprogram), Hart, Huberta E., Ditzel, Kim, Rutten, Guy E., de Groot, Esther, Seidu, Samuel, Khunti, Kamlesh, Vos, Rimke C., Huisartsopleiding, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, HAG Zorginnovatieonderzoek, HAG Diabetes, JC Overig onderzoek, HAG Hart- Vaatziekten, Other research (not in main researchprogram), Hart, Huberta E., Ditzel, Kim, Rutten, Guy E., de Groot, Esther, Seidu, Samuel, Khunti, Kamlesh, and Vos, Rimke C.

Published
2019

6. Fatal cerebral hemorrhage in a patient with thrombotic thrombocytopenic purpura with a normal platelet count during treatment with caplacizumab.

Author

Ditzel, Kim, Mons, Dirk Jan, and Fijnheer, Rob

Subjects
*THROMBOTIC thrombocytopenic purpura, *CEREBRAL hemorrhage, *PLATELET count, *OLDER patients, *PREDNISOLONE
Abstract

Acquired thrombotic thrombocytopenic purpura (aTTP) is a thrombotic microangiopathy with a severe mortality and morbidity. Caplacizumab has recently been approved in the Netherlands as a new therapeutic option in patients with life-threatening organ failure due to aTTP. We describe the case of a 50 year old patient with aTTP who was referred to our hospital for treatment with caplacizumab. After undergoing treatment with plasmapheresis, prednisolone, rituximab and caplacizumab, her platelet count recovered and she was ready to be discharged. Unfortunately, before discharge she developed a fatal intra-cerebral hemorrhage. Fatal hemorrhage as an adverse event of caplacizumab has not been described before. Up to now there is no evidence-based treatment for caplacizumab induced heavy bleeding. [ABSTRACT FROM AUTHOR]

Published
2022
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