Use of Intensive Glycemic Management in Older Adults with Diabetes Mellitus.
J Am Geriatr Soc
; 66(6): 1190-1194, 2018 07.
Article
en En
| MEDLINE
| ID: mdl-29633237
ABSTRACT
OBJECTIVES:
To examine the proportion of older adults with diabetes mellitus treated with tight glucose control and the factors associated with this practice.DESIGN:
Cross-sectional analysis.SETTING:
Outpatient sites in the Diabetes Collaborative Registry (N=151).PARTICIPANTS:
Adults aged 75 and older with type 2 diabetes mellitus (N=42,669). MEASUREMENTS Participants were categorized based on glycosylated hemoglobin (HbA1c) and glucose-lowering medications poor control (HbA1c >9%), moderate control (HbA1c 8-9%), conservative control (HbA1c 7-8%), tight control (HbA1c <7%) with low-risk agents (low risk for hypoglycemia), tight control with high-risk agents, and diet control (HbA1c <7% taking no glucose-lowering medications). We used hierarchical logistic regression to examine participant and site factors associated with tight control and high-risk agents versus conservative or tight control and low-risk agents.RESULTS:
Of 30,696 participants without diet-controlled diabetes, 5,596 (18%) had moderate or poor control, 9,227 (30%) had conservative control, 7,893 (26%) had tight control taking low-risk agents, and 7,980 (26%) had tight control taking high-risk agents. Older age, male sex, heart failure, chronic kidney disease, and coronary artery disease were each independently associated with greater odds of tight control with high-risk agents. There were no differences according to practice specialty (endocrinology, primary care, cardiology) in how aggressively participants were managed.CONCLUSION:
One-quarter of U.S. older adults with type 2 diabetes mellitus are tightly controlled with glucose-lowering medications that have a high risk of hypoglycemia. These results suggest potential overtreatment of a substantial proportion of people and should encourage further efforts to translate guidelines to daily practice.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Hemoglobina Glucada
/
Ajuste de Riesgo
/
Diabetes Mellitus Tipo 2
/
Hipoglucemia
/
Hipoglucemiantes
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Guideline
/
Observational_studies
/
Prevalence_studies
/
Risk_factors_studies
Límite:
Aged
/
Female
/
Humans
/
Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Am Geriatr Soc
Año:
2018
Tipo del documento:
Article
Pais de publicación:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA