Background: We previously demonstrated that carbohydrate restricted nutrition therapy delivered virtually resulted in safe and sustained reduced blood glucose (BG), resulting in deprescription of antihyperglycemic medications in patients with T2D ≤65 years. Given concerns regarding polypharmacy and risk of hypoglycemia (HYPO) in older adults with T2D, this treatment approach may confer benefit.

Methods: At the time of analysis, 279 adults aged ≥65 years at enrollment (27% female, 69±1.6 years, HbA1c: 7.5±1.5%) enrolled in our clinic at least 1 year prior. Data were obtained from medical records to assess changes in BG and medication use among patients retained 1 year and incidence of HYPO in all patients enrolled. Patients provided >1 BG per day on average. Glucose values and patient-reported events were used to identify level 1 (54-69 mg/dL), level 2 (<54 mg/dL), and level 3 (severe requiring third-party assistance) HYPO events.

Results: Among 201 (72%) patients treated 1 year, mean glucose declined (-18.8±3.7 from 147.3±3.8 mg/dL, p<0.001). Among 144 patients taking 231 medications other than metformin at enrollment, 141/231 (61%) of medications were deprescribed, including 45% of insulins and 85% of sulfonylureas. Among the 38 patients still prescribed insulin at 1 year, the average dosage decreased from 98.5±66.0 to 36.2±29.2 IU/day (p<0.001). The average number of diabetes prescriptions per patient declined from 1.2±0.9 to 0.5±0.7 (p<0.001). There were 149 level 1 HYPO events per 100 person-years (p-y), 28 level 2 events per 100 p-y, and no level 3 events reported.

Discussion: The majority of older adults continued treatment for at least 1 year. Improved glycemia concurrent with discontinuation of many high-risk medications and no known severe HYPO events in older adults with T2D suggests this treatment approach may reduce risk and cost associated with polypharmacy and HYPO in older adults with T2D.

Disclosure

R. N. Adams: Employee; Self; Virta Health Corp., Stock/Shareholder; Self; Virta Health Corp. S. J. Athinarayanan: Employee; Self; Virta Health Corp. C. G. P. Roberts: Employee; Self; Virta Health Corp., Stock/Shareholder; Self; Virta Health Corp. B. M. Volk: Employee; Self; Virta Health Corp., Virta Health Corp. B. Fell: None. A. L. Mckenzie: Employee; Self; Virta Health Corp., Stock/Shareholder; Self; Virta Health Corp.

© 2021 by the American Diabetes Association
2021
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