Potential Overtreatment and Overtesting Among Older Adults With Type 2 Diabetes Across Canada: An Observational, Retrospective Cohort Study

Sai Krishna Gudi; Shawn Bugden; Alexander Singer; Jamie Falk

doi:10.1016/j.jcjd.2022.02.010

Potential Overtreatment and Overtesting Among Older Adults With Type 2 Diabetes Across Canada: An Observational, Retrospective Cohort Study

Can J Diabetes. 2022 Mar 6:S1499-2671(22)00022-3. doi: 10.1016/j.jcjd.2022.02.010. Online ahead of print.

Authors

Sai Krishna Gudi¹, Shawn Bugden², Alexander Singer³, Jamie Falk⁴

Affiliations

¹ College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
² School of Pharmacy, Memorial University of Newfoundland, Health Sciences Centre, St. John's, Newfoundland, Canada.
³ Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: jamison.falk@umanitoba.ca.

PMID: 35933318
DOI: 10.1016/j.jcjd.2022.02.010

Abstract

Objective: Our aim in this study was to assess potential overtreatment and overtesting among older adults with type 2 diabetes across Canada.

Methods: An observational, population-based cohort study was conducted using data available through the Canadian Primary Care Sentinel Surveillance Network. All patients included in the study were seen by a primary care provider between 2010 and 2017, ≥65 years with type 2 diabetes and had at least one glycated hemoglobin (A1C) measurement. Potential overtreatment was defined as an index A1C of <7% and being prescribed antidiabetes medications other than metformin within 1 year of the index A1C. Testing ≥3 times/year in patients with A1C <7% was considered potential overtesting. Analyses were performed/compared within 2 cross-sectional cohorts (2012 and 2016). A subcohort analysis was performed on those with advanced age and dementia.

Results: An overall cohort of 41,032 patients (mean age, 76.6 years) was identified. Proportions of potential overtreatment were 7.0% (2012) and 6.9% (2016) (difference in rate in %: 0.1; 95% confidence interval [CI], -0.32 to 0.52]). Overall, 19.2% (2012) and 19.0% (2016) of patients were potentially overtested (difference in rate in %: 0.2; 95% CI, -0.45 to 0.85), whereas 2.4% (2012) and 2.3% (2016) were potentially undertested (difference in rate in %: 0.1; 95% CI, -0.15 to 0.35). Among patients with dementia and advanced age, proportions of patients potentially overtreated were 14.5% and 12.1%, and those overtested were 29.2% and 25.0% in 2012 and 2016, respectively.

Conclusions: Potential overtreatment and overtesting exists among older adults with diabetes in Canadian primary care practices with minimal change over time. Higher proportions of potentially unnecessary care were observed in those with advanced age and dementia. Our study highlights an opportunity for primary care clinicians to improve testing and treatment practices considering the individual patient, context and potential for net benefit.

Keywords: A1C; A1c; older adults; overtesting; overtreatment; personnes âgées; primary care; soins primaires; surtraitement; surévaluation.