Journal of the American Medical Directors Association
Review ArticlePotential Overtreatment and Undertreatment of Type 2 Diabetes Mellitus in Long-Term Care Facilities: A Systematic Review
Section snippets
Methods
This systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement.29 A protocol was published prospectively on PROSPERO 2019 (CRD42019120029).30
Results
Of the 6026 potentially relevant articles retrieved, 15 articles satisfied the inclusion criteria (Supplementary Figure 1). Excluded studies with reasons for exclusion are in Supplementary Table 1. Study characteristics are summarized in Table 2. Studies were conducted in the United States (n = 3),35, 36, 37 Italy (n = 3),38, 39, 40 France (n = 3),41, 42, 43 Norway (n = 1),44 Sweden (n = 1),45 Australia (n = 1),46 Canada (n = 1),47 Japan (n = 1),48 and India (n = 1).49
Discussion
This was the first systematic review to examine the prevalence, outcomes of, and factors associated with potential overtreatment and undertreatment of T2DM in the LTCF setting. Prevalence of potential glycemic overtreatment and undertreatment of T2DM (5%–86% and 1.4%–35%, respectively) varied widely due to the varying definitions of potential overtreatment and undertreatment used. The widely varying prevalence also reflect likely differences in organizational culture and medication management
Conclusion and Implications
This systematic review provides evidence of potential glycemic overtreatment and undertreatment in LTCFs. More studies reported potential overtreatment than potential undertreatment. Residents with dementia, greater ADL impairment, and lower insulin use were more likely to be potentially overtreated. The review compiled a large range of definitions used to describe potential glycemic overtreatment and undertreatment, highlighting the need for standardization. Nevertheless, these definitions may
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JMN has received travel grants from MSD, personal fees for independent education activities and research support from Sanofi, and research funding from Eli Lilly and Boehringer Ingelheim. MH is employed by an organization providing aged care services. JS, SW, JSB, and JKS declare no conflict of interest.
JS is a recipient of the Cyril Tonkin Scholarship for PhD research at the Faculty of Pharmacy and Pharmaceutical Sciences, Monash University. SW is supported by an Australian Government Research Training Program Scholarship. JSB has received research grants paid to his employer from NHMRC, Dementia Australia Research Foundation, Yulgilbar Foundation, Dementia Centre for Research Collaboration, Victorian Government Department of Health and Human Services, GSK Independent Medical Education, Aged Care Quality and Safety Commission, and several aged care provider organizations. JKS is supported by a NHMRC Early Career Fellowship (grant number APP1156439). JMN is supported by a Medical Research Future Fund Next Generation Clinical Researchers Program – TRIP Fellowship (APP1168265). The funders had no role in study design, methods, data collection and analysis, decision to publish or preparation of this manuscript. All authors had final responsibility for the decision to submit for publication.