Key takeaway: An intervention by healthcare professionals reduced the number of older adult patients with type 2 diabetes who were at risk for hypoglycemia (low blood sugar) by almost 50% and resulted in the de-escalation of diabetes medications that cause hypoglycemia in 20% of patients, according to a recently published study.

Among older adults with type 2 diabetes, hypoglycemia from overtreatment is a severe but underappreciated consequence. However, the intensity of diabetic treatment is rarely reduced. To reduce the number of patients at risk for hypoglycemia and the effects of non-severe hypoglycemic events, we evaluated the effectiveness of a Clinical Decision Support (CDS) tool and shared decision-making (SDM). HypoPrevent was a pre-post, single-arm study that enrolled 94 patients (mean age 74; mean HbA1c (±SD)-6.36% ± 0.43) at risk of treatment-related hypoglycemia. During three clinic visits over 6 months, the clinicians used the tool to assess hypoglycemic risk, set individualized HbA1c (blood sugar level) goals, and reduce or discontinue the use of diabetes medications that can cause hypoglycemia.

The at-risk population was cut in half by 46% thanks to the clinical decision support tool and collaborative decision-making, and 20% of participants stopped taking their hypoglycemic drugs as a result. A validated patient-reported outcome assessment (TRIM-HYPO) was also completed by the patients to assess the effect of non-severe hypoglycemia incidents on their daily lives. Due to a decrease in non-severe hypoglycemia incidents, the patients reported improvements in their daily functioning, emotional health, diabetes management, sleep disruption, and work productivity. In conclusion, a low-cost clinical decision support tool, without the additional use of continuous glucose monitoring technology, can decrease the number of patients at high risk for hypoglycemia and reduce overtreatment with insulin and diabetes medications that cause hypoglycemia.

Reference: Koehn DA et al. Reducing hypoglycemia from overtreatment of type 2 diabetes in older adults: The HypoPrevent study. J Am Geriatr Soc. 2023 Sep 21.