Use of Intensive Glycemic Management in Older Adults with Diabetes Mellitus

J Am Geriatr Soc. 2018 Jul;66(6):1190-1194. doi: 10.1111/jgs.15335. Epub 2018 Apr 10.

Abstract

Objectives: To examine the proportion of older adults with diabetes mellitus treated with tight glucose control and the factors associated with this practice.

Design: Cross-sectional analysis.

Setting: Outpatient sites in the Diabetes Collaborative Registry (N=151).

Participants: Adults aged 75 and older with type 2 diabetes mellitus (N=42,669).

Measurements: Participants were categorized based on glycosylated hemoglobin (HbA1c) and glucose-lowering medications: poor control (HbA1c >9%), moderate control (HbA1c 8-9%), conservative control (HbA1c 7-8%), tight control (HbA1c <7%) with low-risk agents (low risk for hypoglycemia), tight control with high-risk agents, and diet control (HbA1c <7% taking no glucose-lowering medications). We used hierarchical logistic regression to examine participant and site factors associated with tight control and high-risk agents versus conservative or tight control and low-risk agents.

Results: Of 30,696 participants without diet-controlled diabetes, 5,596 (18%) had moderate or poor control, 9,227 (30%) had conservative control, 7,893 (26%) had tight control taking low-risk agents, and 7,980 (26%) had tight control taking high-risk agents. Older age, male sex, heart failure, chronic kidney disease, and coronary artery disease were each independently associated with greater odds of tight control with high-risk agents. There were no differences according to practice specialty (endocrinology, primary care, cardiology) in how aggressively participants were managed.

Conclusion: One-quarter of U.S. older adults with type 2 diabetes mellitus are tightly controlled with glucose-lowering medications that have a high risk of hypoglycemia. These results suggest potential overtreatment of a substantial proportion of people and should encourage further efforts to translate guidelines to daily practice.

Keywords: diabetes mellitus; glucose control; hypoglycemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Glucose / analysis
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2* / blood
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / epidemiology
  • Diabetes Mellitus, Type 2* / therapy
  • Diet, Diabetic / methods
  • Female
  • Glycated Hemoglobin / analysis*
  • Humans
  • Hypoglycemia* / chemically induced
  • Hypoglycemia* / diagnosis
  • Hypoglycemia* / prevention & control
  • Hypoglycemic Agents* / administration & dosage
  • Hypoglycemic Agents* / adverse effects
  • Hypoglycemic Agents* / classification
  • Male
  • Risk Adjustment / methods*
  • Risk Assessment
  • United States / epidemiology

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents