Abstract
BackgroundGlycemic control targets in older patients should be individualized according to functional status and comorbidities. The aim of the study was to identify high-risk patients who had evidence of tight glycemic control and thus at risk of serious hypoglycemia.MethodsRetrospective cross-sectional study of type 2 diabetes patients admitted to the geriatric ward receiving diabetes medications. Patients’ hospital records were analyzed. The high risk of hypoglycemia group constituted patients who were aged 80+ years, diagnosed with dementia, with end- stage renal disease, or with a history of macrovascular complications. The primary outcome measure was hemoglobin A1C (HbA1C) ≤ 7.0% [53 mmol/mol].ResultsTwo hundred thirteen patients were included (77.5% women; 49.3% 80+ year-old). 65.3% received sulfonylurea, 39,4%- metformin, 32.9%- insulin, and 4.2%- acarbose (in 61.5% as monotherapy, and in 38.5% combination therapy). We identified 130 patients (60%) as the denominator for the primary outcome measure; 73.1% had a HbA1C value ≤7.0% [53.3 mmol/mol], but 55.4% ≤6,5% [48.8 mmol/mol], and 40.8% ≤6.0% [42 mmol/mol].ConclusionsThe results show a very high rate of tight glycemic control in older patients admitted to the geriatric ward, for whom higher HbA1C targets are recommended. This indicates the high probability of diabetes overtreatment in this group, associated with a high risk of recurrent hypoglycemia. This is all the more likely because most of them received medications known to cause hypoglycemia. This points to the need of paying more attention to specific difficulties in diabetes treatment in older people, especially those suffering from various geriatric syndromes and diseases worsening their prognosis.
Highlights
Glycemic control targets in older patients should be individualized according to functional status and comorbidities
Study parameters We identified a “high risk of hypoglycemia group”- patients with diabetes treated with antidiabetic medications and having at least one of the following additional criteria: age 80 years or older, severe stage of chronic kidney disease (CKD) i.e. stage 4 and 5 CKD according to Kidney Disease Outcome Quality Initiative (KDOQI)glomerular filtration rate Glomerular filtration rate (GFR) < 30 ml/min/1.73m2, a diagnosis of dementia confirmed at discharge, a history of cardiovascular or vascular complications
Two hundred thirteen patients who were treated with insulin and/or oral glucose lowering agents before hospitalization, and who had HbA1c test result performed at admission, were included in the study- Fig. 1 shows patients enrolment in the study
Summary
Glycemic control targets in older patients should be individualized according to functional status and comorbidities. Instead of a reduced risk of cardiovascular diseases, a growing risk of severe hypoglycemia was reported in patients with a number of coexisting diseases and long-term diabetes [9] This supports the need for early diagnosis followed by intensive therapy of diabetes, and indicates that the benefits of such treatment are limited in the older population of patients with a long-term disease and short expected survival [10, 11]. The necessity of therapy individualization based on patients’ characteristics was emphasized, in particular- their ability to identify and manage hypoglycemia In older patients, this ability may be significantly adversely affected by common geriatric comorbidities such as functional disability, depression or dementia, to which diabetes predisposes [12, 13]. In 2011 year the European Diabetes Working Party for Older People (EDWPOP) based the therapeutic goals in diabetes on the older patient’s status, and recommended HbA1C levels of 7–7.5% [53-58 mmol/mol] for older patients in good health, and 7.6–8.5% [60-69 mmol/mol] for the frail ones [15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
