A Randomized Trial of Alerting to Low Glycated Hemoglobin Level in Older Adults: Results of the Low Indexes of Metabolism Intervention Trial B (LIMIT-B)

Nir Tsabar, Yan Press, Johanna Rotman, Bracha Klein, Yonatan Grossman, Maya Vainshtein-Tal, Sophia Eilat-Tsanani

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objectives: The benefit of alerting clinical staff to low plasma glycated hemoglobin (HbA1c) in patients aged 75 years and older who receive antidiabetic drugs remains uncertain. Design, Setting, and Participants: In a randomized controlled trial, 1684 patients with HbA1c ≤ 6.5% who received antidiabetic drugs were assigned to have an e-mail alert sent to their physician, and 1643 were assigned to have no such alert (control group). The primary outcome of the trial was annual death. Secondary outcomes included antidiabetic drug dose reduction and HbA1c change. Results: In the first quarter, antidiabetic drug-defined daily doses were reduced on average by 10.4 ± 35.8 (16% ± 55%) in the intervention group and by 6.4 ± 36.1 (10% ± 56%) in the control group (difference −4.1 ± 1.2, 95% confidence interval [CI] −6.5 to −1.6; P = .001). Measured HbA1c levels were raised by a mean (± standard deviation) of 0.28 ± 0.77 in the intervention group and by 0.18 ± 0.57 in the control group (difference 0.10 ± 0.02, 95% CI –0.15 to −0.059, P < .001). One year after the alerts, 121 patients (7.2%) died in the intervention group and 107 patients (6.5%) died in the control group (relative risk 1.1, 95% CI 0.86-1.42; P = .44). Conclusions and Implications: In this trial, alerting clinical staff to low HbA1c in patients aged 75 years and older treated with antidiabetic medicines was associated with mildly reduced antidiabetic doses and increased HbA1c but was not associated with a significant difference in survival rate compared with usual clinical care.

Original languageEnglish
Pages (from-to)277-280.e3
JournalJournal of the American Medical Directors Association
Volume21
Issue number2
DOIs
StatePublished - Feb 2020

Bibliographical note

Publisher Copyright:
© 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine

Funding

This work was supported by Dangoor Personalized Medicine Fund at Bar-Ilan University. The Dangoor fund was not involved in the design, methods, subject recruitment, data collections, analysis and preparation of the paper.

FundersFunder number
Dangoor Personalized Medicine Fund at Bar-Ilan University

    Keywords

    • Aged
    • aged 80 and older
    • electronic mail
    • iatrogenic disease
    • low HbA1c
    • randomized controlled trial

    Fingerprint

    Dive into the research topics of 'A Randomized Trial of Alerting to Low Glycated Hemoglobin Level in Older Adults: Results of the Low Indexes of Metabolism Intervention Trial B (LIMIT-B)'. Together they form a unique fingerprint.

    Cite this