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

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