Endocrine Abstracts

Background: Optimal glucose management in older people is currently unclear. Recent guidelines recommend avoiding tight glycemic targets in elderly patients with comorbidities because intensive control is unlikely to achieve benefit and they are at higher risk of hypoglycaemia.

Objective: To estimate the prevalence of potential overtreatment in older adults with diabetes mellitus and comorbidities.

Design: Cross-sectional study.

Patients and methods: The study included 293 type 1 and type 2 diabetic patients that were monitored from 2004 to 2014. At the end of follow-up, 166 (56.7% of final cohort) patients were older than 70 years (DM2: 95.2%; 69.3% female and long-standing diabetes, 26.6 years). Data about treatment, glycemic control, and comorbidities were collected from clinical records of these patients.

Results: Sixty-eight patients (42.5%) had an HbA1c <7%. These patients had significant advanced mean age (80.2 vs 78.4 years) (P<0.05). Their mean diabetes duration was 25.5 years, most of them were female (70.6%) and almost half (47%) had either macrovascular disease, estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m² (<60) or both.

Anti-diabetic therapy was insulin based in 58 (85%), sulfonylureas or glinide based in 7 (10.8%) and combined both insulin and secretagogues in 4 (5.9%). In insulin-treated patients, more than two-thirds (78%) were on intensified regimen.

Among patients with macrovascular disease, eGFR <60 or both, 21(61%) were treated with intensified insulin regimen. Only one patient received secretagogues.

Conclusions: Our results indicate that nearly half of our elderly patients had a strict glycemic control and the majority of them are being treated with intensified insulin regimen, secretagogues or combination of both and therefore are potentially being overtreated.

In all, more than half of these elderly patients with strict glycemic control and comorbidities are being treated with intensified insulin therapy or secretagogues, putting them at risk of adverse hypoglycemic events.