Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control | Journal Scan

Jan 12, 2015
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Authors:
Lipska KJ, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA.
Citation:
JAMA Intern Med 2014;Jan 12:[Epub ahead of print].
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

What are glycemic control levels among older adults with diabetes mellitus categorized by health status?

Methods:

This was a cross-sectional analysis of adults from the National Health and Nutrition Examination Survey (NHANES) who were 65 years or older. Participants were enrolled from 2001 through 2010. Patients were classified into the following three health status categories: very complex/poor (difficulty with two or more activities of daily living or dialysis dependence), complex/intermediate (difficulty with two or more instrumental activities of daily living or presence of three more chronic conditions), and relatively healthy. Glucose control, based on glycated hemoglobin (HbA1c) level, was classified as tight (HbA1c <7%), moderate (HbA1c 7-8.9%), and poor (>9%). The authors calculated proportions of participants with poor, moderate, or tight glycemic control across health status categories.

Results:

The analytic sample included 1,288 participants; 61.5% of participants (95% confidence interval [CI], 57.5%-65.3%) had tight glycemic control. There were no significant differences in the proportions of patients who attained tight glycemic control across health status categories (p = 0.43). Of older adults with tight glycemic control, 54.9% (95% CI, 50.4%-59.3%) were treated with either insulin or sulfonylureas; this was similar across health status categories.

Conclusions:

In a nationally representative sample of older adults with diabetes mellitus, most (62%) had tight glycemic control with an HbA1c <7.0%.

Perspective:

This is an important study that suggests the potential overtreatment of older adults with diabetes mellitus. While the authors establish that a significant number of patients had tight glycemic control, they were not able to determine whether such strict glycemic control was associated with harm/hypoglycemia. Nonetheless, select adults may be vulnerable to the harms of aggressive treatment targets.

Keywords: Activities of Daily Living, Blood Glucose, Chronic Disease, Confidence Intervals, Cross-Sectional Studies, Diabetes Mellitus, Health Status, Glycated Hemoglobin A, Hypoglycemia, Insulin, Nutrition Surveys, Renal Dialysis, Sulfonylurea Compounds


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