Glycemic overtreatment among very old adults with type 2 diabetes mellitus
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)
Keywords: type 2 diabetes mellitussevere hypoglycemiaglycated hemoglobin A1cvery old people
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