Arnold SV, et al. - Researchers probed the proportion of older adults with diabetes mellitus treated with tight glucose control and the factors associated with this practice. They noted a tight control of one-quarter of U.S. older adults having type 2 diabetes mellitus with glucose-lowering medications that have a high risk of hypoglycemia. Potential overtreatment of a substantial proportion of people was suggested by these results.

Methods

• Experts conducted this Cross-sectional analysis from outpatient sites in the Diabetes Collaborative Registry (N=151).
• They included adults aged 75 and older with type 2 diabetes mellitus (N=42,669).
• Authors categorized participants 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).
• In order to examine participant and site factors related to tight control and high-risk agents vs conservative or tight control and low-risk agents hierarchical logistic regression was used.

Results

• As per data, among 30,696 participants without diet-controlled diabetes, 5,596 (18%) demonstrated moderate or poor control, 9,227 (30%) demonstrated conservative control, 7,893 (26%) showed tight control taking low-risk agents, and 7,980 (26%) had tight control taking high-risk agents.
• Findings suggested independent association of older age, male sex, heart failure, chronic kidney disease, and coronary artery disease with greater odds of tight control with high-risk agents.
• Experts did not note any differences according to practice specialty (endocrinology, primary care, cardiology) in how aggressively participants were managed.