Many Older Type 2 Diabetes Patients Are Overtreated

Many older patients with type 2 diabetes are overtreated for their condition, which could potentially lead to serious consequences, a new study found.

For their study, the researchers assessed the level of personalized diabetes treatment for 1002 older patients in primary care, of whom 319 were aged at least 70 years.
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Using Dutch guidelines, the researchers categorized patients aged 70 years or older into groups of different glycated hemoglobin (HbA_1c) treatment targets, which included 7% (53 mmol/mol), 7.5% (58 mmol/mol) and 8% (64 mmol/mol).

Results showed that patients with HbA_1c targets of more than 7% (n = 165) were the most susceptible to microvascular and macrovascular complications, often used at least 5 medicines, and were often frail compared with patients with HbA_1c targets of 7% or lower.

Ultimately, 64 patients (38.8% of all patients; 20% of all patients aged 70 years or older) with HbA_1c targets of more than 7%  were found to be overtreated. A total of 20.3% of these patients had hypoglycemia, and nearly 30% had accidents involving falls.

Importantly, the researchers emphasized that personalized treatment in older type 2 diabetes patients is not common practice.

“A substantial number of older people are overtreated, with probable harmful consequences,” the researchers wrote. “To prevent overtreatment, definition of lower HbA1c limits might be helpful.”

—Christina Vogt

Reference:

Hart HE, Rutten GE, Bontje KN, Vos RC. Overtreatment of older patients with type 2 diabetes mellitus in primary care [Published online January 24, 2018]. Diabetes Obes Metab. doi:10.1111/dom.13174.