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Vol 7, No 2 (2018)
ORIGINAL ARTICLES
Published online: 2018-04-04
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Glycemic overtreatment among very old adults with type 2 diabetes mellitus

Melania Mikołajczyk-Solińska, Marcin Kosmalski, Józef Drzewoski
DOI: 10.5603/DK.2018.0004
·
Clinical Diabetology 2018;7(2):102-107.

open access

Vol 7, No 2 (2018)
ORIGINAL ARTICLES
Published online: 2018-04-04

Abstract

Introduction. In older type 2 diabetes mellitus (T2DM) patients with serious comorbidities, tight glycemic control exceeds the benefits. The aim of the study was to assess glycated hemoglobin A1c (HbA1c) in hospital­ized T2DM patients aged ≥ 80 years and to compare the level of HbA1c in diabetics with and without severe hypoglycemia (SH) at admission.

Material and methods. We enrolled 166 consecutive T2DM patients ≥ 80 years of age with a wide spectrum of comorbidities hospitalized between 2009–2013.

Results. Patients’ mean age was 83.72 ± 3.19 years and mean diabetes duration was 9.14 ± 5.88 years, body mass index (BMI) was 27.87 ± 4.51 kg/m² and the glomerular filtration rate (GFR) was 58.94 ± 25.87 ml/ /min/1.73 m². Mean HbA1c for the whole group was 7.61 ± 1.87% (59.77 ± 20.48 mmol/mol). Tight glycemic con­trol with HbA1c < 7.0% (53 mmol/mol) was observed in 77 patients (46%). SH was diagnosed in 19 (11%) patients. Subjects with SH had significantly lower mean HbA1c level than those hospitalized for other reason [6.38 ± 1.22 vs. 7.77 ± 1.88% (46.31 ± 13.36 vs. 61.51 ± 20.63 mmol/ /mol), p = 0.002]. A history of myocardial infarction and/ /or stroke was reported almost two-fold more frequently by the diabetics hospitalized for SH than diabetics with­out hypoglycaemia (47 vs. 28%, c² = 3,03, p = 0.082). SH was diagnosed only in patients receiving insulin (n = 10) or sulfonylurea (n = 9).

Conclusion. Despite the fact, that harms of intensive hypogylcemic treatment exceed the benefits for older patients with T2DM, half of them reached tight gly­cemic control. Every tenth patient was hospitalized because of SH. Subjects with SH had significantly lower mean HbA1c level than those hospitalized for other reason. Our observations suggest that a substantial proportion of T2DM patients ≥ 80 years may be over­treated. (Clin Diabetol 2018; 7, 2: 102–107)  

Abstract

Introduction. In older type 2 diabetes mellitus (T2DM) patients with serious comorbidities, tight glycemic control exceeds the benefits. The aim of the study was to assess glycated hemoglobin A1c (HbA1c) in hospital­ized T2DM patients aged ≥ 80 years and to compare the level of HbA1c in diabetics with and without severe hypoglycemia (SH) at admission.

Material and methods. We enrolled 166 consecutive T2DM patients ≥ 80 years of age with a wide spectrum of comorbidities hospitalized between 2009–2013.

Results. Patients’ mean age was 83.72 ± 3.19 years and mean diabetes duration was 9.14 ± 5.88 years, body mass index (BMI) was 27.87 ± 4.51 kg/m² and the glomerular filtration rate (GFR) was 58.94 ± 25.87 ml/ /min/1.73 m². Mean HbA1c for the whole group was 7.61 ± 1.87% (59.77 ± 20.48 mmol/mol). Tight glycemic con­trol with HbA1c < 7.0% (53 mmol/mol) was observed in 77 patients (46%). SH was diagnosed in 19 (11%) patients. Subjects with SH had significantly lower mean HbA1c level than those hospitalized for other reason [6.38 ± 1.22 vs. 7.77 ± 1.88% (46.31 ± 13.36 vs. 61.51 ± 20.63 mmol/ /mol), p = 0.002]. A history of myocardial infarction and/ /or stroke was reported almost two-fold more frequently by the diabetics hospitalized for SH than diabetics with­out hypoglycaemia (47 vs. 28%, c² = 3,03, p = 0.082). SH was diagnosed only in patients receiving insulin (n = 10) or sulfonylurea (n = 9).

Conclusion. Despite the fact, that harms of intensive hypogylcemic treatment exceed the benefits for older patients with T2DM, half of them reached tight gly­cemic control. Every tenth patient was hospitalized because of SH. Subjects with SH had significantly lower mean HbA1c level than those hospitalized for other reason. Our observations suggest that a substantial proportion of T2DM patients ≥ 80 years may be over­treated. (Clin Diabetol 2018; 7, 2: 102–107)  

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Keywords

type 2 diabetes mellitus, severe hypoglycemia, glycated hemoglobin A1c, very old people

About this article
Title

Glycemic overtreatment among very old adults with type 2 diabetes mellitus

Journal

Clinical Diabetology

Issue

Vol 7, No 2 (2018)

Pages

102-107

Published online

2018-04-04

DOI

10.5603/DK.2018.0004

Bibliographic record

Clinical Diabetology 2018;7(2):102-107.

Keywords

type 2 diabetes mellitus
severe hypoglycemia
glycated hemoglobin A1c
very old people

Authors

Melania Mikołajczyk-Solińska
Marcin Kosmalski
Józef Drzewoski

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