Many older adults fail to place a high importance on factors recommended by guidelines to individualize diabetes treatment, according to a study published in JAMA Internal Medicine.
In this cross-sectional national survey study that included 818 participants (mean age, 74, 53.7% male, 67.7% white) participants place into one of two vignettes: one about adding and the other about removing diabetes medications from treatment plans. Participants rated the importance of 7 factors (diabetes duration, established diabetes complications, other health conditions, life expectancy, risk of adverse effects, cost, and treatment effort) in these treatment decisions using binary (yes/no) responses and the best-worst scaling method to quantify the factors’ relative importance. Subsequently, participants answered questions on how different levels of each factor were associated with aggressiveness of diabetes treatment.
According to the results of the study, a total of 410 participants answered questions about adding medicine, whereas 408 participants answered questions about stopping medicine. Of the 7 factors to consider for adding a diabetes medication to the treatment plan, the number who deemed each factor important ranged from 197 (45.6%) to 263 (62.8%). Conversely, those same factors were considered important by only 29 (8.4%) to 146 (37.7%) of participants when deciding to discontinue use of a diabetes medication. In both cases, the study subjects perceived the risk of adverse effects as the most important factor. In contrast to current guideline recommendations, most participants believed that patients with longer disease duration (498 [60.1%]), more established complications (632 [75.6%]), and greater number of other health conditions (545 [67.5%]) should receive more aggressive diabetes treatment.
This is why we need patient participation on CPGs…
Patient Perceptions of Diabetes Guideline Frameworks for Individualizing Glycemic Targets https://t.co/wWtOJr2u3R— Doreen Rabi, M.D. (@doreen_rabi) September 16, 2019
The authors wrote in their conclusion that “when considering treatment aggressiveness, many older adults weighted several factors in the opposite direction than suggested by the guidelines. Individualizing diabetes care in older adults will require effective communication regarding the benefits and consequences of making changes to treatment plans.”
Older adult perceptions on DM. Pts "believed that patients with longer disease duration, more established complications, and more other health conditions should receive more aggressive treatment". This is unfortunately how the medical system works too… https://t.co/xNeXCI4NRO
— Sandra Shi (@shisadoctor) September 17, 2019
What factors should influence prescribing and #deprescribing of diabetes meds? Patients' opinions are far from those recommended by guidelines and should inform how discussions occur. Great piece by Nancy Schoenborn & Cynthia Boyd https://t.co/B0JFdqscoK pic.twitter.com/k6ZZ68qgpM
— Mike Steinman (@MikeSteinman) September 17, 2019
© 2025 Mashup Media, LLC, a Formedics Property. All Rights Reserved.