Are Older Diabetes Patients Overtreated?

This was a retrospective time trend study analyzing the prevalence of overtreatment of geriatric patients with type 2 diabetes (T2D). The study included two retrospective cross-sectional cohort studies of T2D patients admitted to a geriatric ward during two time periods: 2009–2010 (first round) and 2014–2015 (second round). Patients were classified as high-risk based on the following factors: taking antihyperglycemic medications prior to admission, age ≥ 80 years, dementia diagnosis, end-stage renal disease, or a history of macrovascular complications. The main outcome was glycosylated A1C hemoglobin (HbA1C) ≤7.0% (53 mmol/mol). Final analysis included 213 patients in the first round and 83 patients in the second round. Age, sex, health, and functional characteristics did not largely differ between the groups, but higher rates were observed in the second round of dementia (36.1% vs. 18.8%, P=0.002) and high-risk cases (79.3% vs. 67.7%, P=0.05). The prevalence of tight glycemic control in the high-risk group significantly decreased (73.1% to 58.5%, P=0.04), and the median value of HbA1c significantly increased (6.4% [46 mmol/mol] to 6.7% [50 mmol/mol], P=0.03). The authors concluded that even though individualized diabetes therapy was in effect, diabetes overtreatment remained a significant concern among geriatric patients, “although a positive trend was noted in this respect,” they noted.