Skip to main content
Top
Published in: The journal of nutrition, health & aging 10/2017

01-12-2017

Inadequate glycaemic control and therapeutic management of adults over 65 years old with type 2 diabetes mellitus in Spain

Authors: Francesc Formiga, J. Franch-Nadal, L. Rodriguez, L. Ávila, E. Fuster

Published in: The journal of nutrition, health & aging | Issue 10/2017

Login to get access

Abstract

Objectives

The glycaemic goals for older patients with type 2 diabetes mellitus (DM) are recommended to avoid an HbA1c levels <7%. The purpose of this study was to analyse the glycaemic control and therapeutic management of older adults (≥65 years) with type 2 DM.

Design

Pooled analysis of patients enrolled in three Spanish cross-sectional epidemiological studies.

Setting

The study was conducted between 2009 and 2011 by primary care or specialist physicians.

Participants

A total of 7,269 patients aged ≥65 years with type 2 DM.

Measurements

Sociodemographic, medical history, lifestyle habits, biochemical laboratory parameters, comorbidities, type 2 DM complications, and pharmacological treatment data collected from medical records.

Results

In total, data from 7,269 patients were analysed (mean age 73.4 years old; 48.4% male). A total of 10.9% of patients had HbA1c levels ≥8.5% and 43.2% <7%. The most common comorbidities were hypertension (82.0%) and dyslipidaemia (76.6%). The microvascular complications were mainly diabetic nephropathy (23.6%) and retinopathy (19.3%). Oral antidiabetic drugs (OADs) were taken by 70.5% of patients (sulphonylureas 65.3%), 4.1% were taking insulin alone and 25.4% took both insulin and an OAD. Half of the patients (51.0%) were taking a combination of OADs.

Conclusion

In conclusion, more than half of older patients with type 2 DM had unsatisfactory management: approximately one in ten had inadequate glycaemic control (HbA1c ≥8.5%) despite hypoglycaemic drugs and four in ten were potentially overtreated (HbA1c <7%).
Literature
1.
go back to reference IDF Global Guideline for Managing Older People with Type 2 Diabetes. In: Int. Diabetes Fed. https://www.idf.org/guidelines/managing-older-people-type-2-diabetes. Accessed 10 May 2016 IDF Global Guideline for Managing Older People with Type 2 Diabetes. In: Int. Diabetes Fed. https://​www.​idf.​org/​guidelines/​managing-older-people-type-2-diabetes.​ Accessed 10 May 2016
2.
go back to reference Sinclair AJ, Paolisso G, Castro M, et al. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab 2011;37 Suppl 3:S27–38. doi: 10.1016/S1262-3636(11)70962-4CrossRefPubMed Sinclair AJ, Paolisso G, Castro M, et al. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab 2011;37 Suppl 3:S27–38. doi: 10.1016/S1262-3636(11)70962-4CrossRefPubMed
4.
go back to reference Gómez Huelgas R, Díez-Espino J, Formiga F, et al. [Treatment of type 2 diabetes in the elderly]. Med Clínica 2013;140:134.e1-134.e12. doi: 10.1016/j. medcli.2012.10.003 Gómez Huelgas R, Díez-Espino J, Formiga F, et al. [Treatment of type 2 diabetes in the elderly]. Med Clínica 2013;140:134.e1-134.e12. doi: 10.1016/j. medcli.2012.10.003
5.
go back to reference Dunning T, Sinclair A, Colagiuri S. New IDF Guideline for managing type 2 diabetes in older people. Diabetes Res Clin Pract 2014;103:538–540. doi: 10.1016/j.diabres.2014.03.005CrossRefPubMed Dunning T, Sinclair A, Colagiuri S. New IDF Guideline for managing type 2 diabetes in older people. Diabetes Res Clin Pract 2014;103:538–540. doi: 10.1016/j.diabres.2014.03.005CrossRefPubMed
6.
go back to reference Bramlage P, Gitt AK, Binz C, et al. Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia. Cardiovasc Diabetol 2012;11:122. doi: 10.1186/1475-2840-11-122CrossRefPubMedPubMedCentral Bramlage P, Gitt AK, Binz C, et al. Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia. Cardiovasc Diabetol 2012;11:122. doi: 10.1186/1475-2840-11-122CrossRefPubMedPubMedCentral
7.
go back to reference Du Y-F, Ou H-Y, Beverly EA, Chiu C-J. Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options. Clin Interv Aging 2014;9:1963–1980. doi: 10.2147/CIA.S53482PubMedPubMedCentral Du Y-F, Ou H-Y, Beverly EA, Chiu C-J. Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options. Clin Interv Aging 2014;9:1963–1980. doi: 10.2147/CIA.S53482PubMedPubMedCentral
8.
go back to reference Lipska KJ, Ross JS, Miao Y, et al. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med 2015;175:356–362. doi: 10.1001/jamainternmed.2014.7345CrossRefPubMedPubMedCentral Lipska KJ, Ross JS, Miao Y, et al. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med 2015;175:356–362. doi: 10.1001/jamainternmed.2014.7345CrossRefPubMedPubMedCentral
9.
go back to reference Font B, Lahoz R, Roldan C, et al. DB3 How a Fear of Hypoglycemia Influences Health-Related Quality of Life in Type 2 Diabetes Mellitus Patients in Spain? Hipoqol-II Study. Value Health 2012;15:A277. doi: 10.1016/j.jval.2012.08.470CrossRef Font B, Lahoz R, Roldan C, et al. DB3 How a Fear of Hypoglycemia Influences Health-Related Quality of Life in Type 2 Diabetes Mellitus Patients in Spain? Hipoqol-II Study. Value Health 2012;15:A277. doi: 10.1016/j.jval.2012.08.470CrossRef
10.
go back to reference Gomis R, Artola S, Conthe P, et al. Prevalencia en consultas de diabetes mellitus tipo 2 en pacientes con sobrepeso u obesidad en España. Estudio OBEDIA. Med Clínica 2014;142:485–492. doi: 10.1016/j.medcli.2013.03.013CrossRef Gomis R, Artola S, Conthe P, et al. Prevalencia en consultas de diabetes mellitus tipo 2 en pacientes con sobrepeso u obesidad en España. Estudio OBEDIA. Med Clínica 2014;142:485–492. doi: 10.1016/j.medcli.2013.03.013CrossRef
11.
go back to reference Javier Escalada F, Ezkurra P, Ferrer JC, et al. Análisis sobre los motivos de derivación de pacientes con diabetes mellitus tipo 2 entre atención primaria y atención especializada. Estudio Pathways. Av En Diabetol 2013;29:60–67. doi: 10.1016/j.avdiab.2013.03.001CrossRef Javier Escalada F, Ezkurra P, Ferrer JC, et al. Análisis sobre los motivos de derivación de pacientes con diabetes mellitus tipo 2 entre atención primaria y atención especializada. Estudio Pathways. Av En Diabetol 2013;29:60–67. doi: 10.1016/j.avdiab.2013.03.001CrossRef
12.
go back to reference Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461–470. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461–470.
13.
go back to reference Finucane TE. “Tight control” in geriatrics: the emperor wears a thong. J Am Geriatr Soc 2012;60:1571–1575. doi: 10.1111/j.1532-5415.2012.04057.xCrossRefPubMed Finucane TE. “Tight control” in geriatrics: the emperor wears a thong. J Am Geriatr Soc 2012;60:1571–1575. doi: 10.1111/j.1532-5415.2012.04057.xCrossRefPubMed
14.
go back to reference Sinclair A, Dunning T, Rodriguez-Mañas L. Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol 2015;3:275–285. doi: 10.1016/S2213-8587(14)70176-7CrossRefPubMed Sinclair A, Dunning T, Rodriguez-Mañas L. Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol 2015;3:275–285. doi: 10.1016/S2213-8587(14)70176-7CrossRefPubMed
15.
go back to reference Barrot-de la Puente J, Mata-Cases M, Franch-Nadal J, et al. Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database. Int J Clin Pract 2015;69:1486–1495. doi: 10.1111/ijcp.12741CrossRefPubMedPubMedCentral Barrot-de la Puente J, Mata-Cases M, Franch-Nadal J, et al. Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database. Int J Clin Pract 2015;69:1486–1495. doi: 10.1111/ijcp.12741CrossRefPubMedPubMedCentral
16.
go back to reference Bouillet B, Vaillant G, Petit J-M, et al. Are elderly patients with diabetes being overtreated in French long-term-care homes? Diabetes Metab 2010;36:272–277. doi: 10.1016/j.diabet.2010.01.009CrossRefPubMed Bouillet B, Vaillant G, Petit J-M, et al. Are elderly patients with diabetes being overtreated in French long-term-care homes? Diabetes Metab 2010;36:272–277. doi: 10.1016/j.diabet.2010.01.009CrossRefPubMed
17.
go back to reference Kim KS, Kim SK, Sung KM, et al. Management of type 2 diabetes mellitus in older adults. Diabetes Metab J 2012;36:336–344. doi: 10.4093/dmj.2012.36.5.336CrossRefPubMedPubMedCentral Kim KS, Kim SK, Sung KM, et al. Management of type 2 diabetes mellitus in older adults. Diabetes Metab J 2012;36:336–344. doi: 10.4093/dmj.2012.36.5.336CrossRefPubMedPubMedCentral
18.
go back to reference Fu H, Curtis BH, Schuster DP, et al. Treatment patterns among older patients with type 2 diabetes in the United States: a retrospective cohort study. Diabetes Technol Ther 2014;16:833–839. doi: 10.1089/dia.2014.0039CrossRefPubMed Fu H, Curtis BH, Schuster DP, et al. Treatment patterns among older patients with type 2 diabetes in the United States: a retrospective cohort study. Diabetes Technol Ther 2014;16:833–839. doi: 10.1089/dia.2014.0039CrossRefPubMed
19.
go back to reference Souza JG, Apolinario D, Magaldi RM, et al. Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study. BMJ Open 2014;4:e004180. doi: 10.1136/bmjopen-2013-004180CrossRefPubMedPubMedCentral Souza JG, Apolinario D, Magaldi RM, et al. Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study. BMJ Open 2014;4:e004180. doi: 10.1136/bmjopen-2013-004180CrossRefPubMedPubMedCentral
Metadata
Title
Inadequate glycaemic control and therapeutic management of adults over 65 years old with type 2 diabetes mellitus in Spain
Authors
Francesc Formiga
J. Franch-Nadal
L. Rodriguez
L. Ávila
E. Fuster
Publication date
01-12-2017
Publisher
Springer Paris
Published in
The journal of nutrition, health & aging / Issue 10/2017
Print ISSN: 1279-7707
Electronic ISSN: 1760-4788
DOI
https://doi.org/10.1007/s12603-017-0869-4

Other articles of this Issue 10/2017

The journal of nutrition, health & aging 10/2017 Go to the issue