(049) Hypoglycaemia Risk and Medication De-intensification in Diabetes Patients: A Cohort Study

Background: Patients receiving glucose-lowering medication can be at risk of hypoglycaemia. Previously, an algorithm was developed to calculate their hypoglycaemia risk based on demographics and dispensing data. This score can be used to screen and identify patients that may require treatment de-intensification. Not much is known, however, about the current potential need and occurrence of de-intensification among diabetes patients in a primary care setting.

Objectives: To identify the prevalence of patients with an estimated high-risk score of hypoglycaemia and describe subsequent treatment changes in primary care diabetes patients. Secondary objective is to investigate patient characteristics associated with treatment de-intensification.

Methods: A cohort study with a 1-year follow-up using the IADB.nl pharmacy database was conducted. Patients aged 35 years or older, who received at least two glucose-lowering medication dispensings (ATC code: A10) in 2019 and were not using only insulin in the preceding 5 years were included. Hypoglycaemia risk was determined using a validated algorithm based on patient characteristics and dispensing data at the index date (i.e., first A10 dispensing in 2019). The hypoglycaemia risk score ranged between 0 and 1, where 0.6 was determined to be the cut-off between low and high hypoglycaemia risk. An anniversary method was used to evaluate treatment changes after 1 year, which were classified as de-intensification, no change or intensification. Factors associated with treatment de-intensification were assessed by multinomial logistic regression.

Results: Around one-quarter (26.9%) of the included patients had a high-risk hypoglycaemia score. After 1-year follow-up, the majority of these high-risk patients (88.9%) experienced no treatment changes. De-intensification was observed for 8.8% and intensification for 2.3%. Having a high-risk score, being female, and younger age were associated with de-intensification.

Conclusions: A substantial number of primary care patients using glucose-lowering medication may be at risk of hypoglycaemia, whereas few of them undergo treatment de-intensification. Assessing hypoglycaemia risk with routinely available data can help health professionals to identify patients at increased risk and consider the need for treatment de-intensification.