Overtreatment and associated risk factors among multimorbid older patients with diabetes.

Baretella, Oliver; Alwan, Heba; Feller, Martin; Aubert, Carole; Del Giovane, Cinzia; Papazoglou, Dimitrios; Christiaens, Antoine; Meinders, Arend-Jan; Byrne, Stephen; Kearney, Patricia M; O'Mahony, Denis; Knol, Wilma; Boland, Benoît; Gencer, Baris; Aujesky, Drahomir; Rodondi, Nicolas (2023). Overtreatment and associated risk factors among multimorbid older patients with diabetes. Journal of the American Geriatrics Society, 71(9), pp. 2893-2901. Wiley 10.1111/jgs.18465

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In multimorbid older patients with type 2 diabetes mellitus (T2DM), the intensity of glucose-lowering medication (GLM) should be focused on attaining a suitable level of glycated hemoglobin (HbA1c ) while avoiding side effects. We aimed at identifying patients with overtreatment of T2DM as well as associated risk factors.


In a secondary analysis of a multicenter study of multimorbid older patients, we evaluated HbA1c levels among patients with T2DM. Patients were aged ≥70 years, with multimorbidity (≥3 chronic diagnoses) and polypharmacy (≥5 chronic medications), enrolled in four university medical centers across Europe (Belgium, Ireland, Netherlands, and Switzerland). We defined overtreatment as HbA1c  < 7.5% with ≥1 GLM other than metformin, as suggested by Choosing Wisely and used prevalence ratios (PRs) to evaluate risk factors of overtreatment in age- and sex-adjusted analyses.


Among the 564 patients with T2DM (median age 78 years, 39% women), mean ± standard deviation HbA1c was 7.2 ± 1.2%. Metformin (prevalence 51%) was the most frequently prescribed GLM and 199 (35%) patients were overtreated. The presence of severe renal impairment (PR 1.36, 1.21-1.53) and outpatient physician (other than general practitioner [GP], i.e. specialist) or emergency department visits (PR 1.22, 1.03-1.46 for 1-2 visits, and PR 1.35, 1.19-1.54 for ≥3 visits versus no visits) were associated with overtreatment. These factors remained associated with overtreatment in multivariable analyses.


In this multicountry study of multimorbid older patients with T2DM, more than one third were overtreated, highlighting the high prevalence of this problem. Careful balancing of benefits and risks in the choice of GLM may improve patient care, especially in the context of comorbidities such as severe renal impairment, and frequent non-GP healthcare contacts.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Baretella, Oliver, Al-Alwan, Heba, Feller, Martin, Aubert, Carole Elodie, Del Giovane, Cinzia, Papazoglou, Dimitrios David, Gencer, Baris Faruk, Aujesky, Drahomir, Rodondi, Nicolas


300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health






[222] Horizon 2020 ; [4] Swiss National Science Foundation ; [201] Staatssekretariat für Bildung, Forschung und Innovation (SBFI) = Swiss State Secretariat for Education, Research and Innovation (SERI)




Pubmed Import

Date Deposited:

08 Jun 2023 14:19

Last Modified:

23 Sep 2023 08:11

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

HbA1c glucose-lowering medication multimorbidity polypharmacy type 2 diabetes mellitus





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