A retrospective study of diabetes treatment in older adults: what should we AIM for?

ABSTRACT

Objectives

Management of diabetes in elderly individuals requires a complex approach, considering the negative consequences. Glycemic overtreatment and undertreatment are relatively common conditions among this population. This study aimed to determine the potential overtreatment and undertreatment frequencies in older adults and the factors associated with these conditions.

Methods

This retrospective study included 405 diabetic older adults aged >65 years. Sociodemographic characteristics, additional comorbidities, medications, HbA1c and fasting glucose levels of the patients have been recorded.

Results

The median age of the patients was 71 years. The frequency of potential overtreatment and undertreatment has been found to be 20.2% and 17.8%, respectively. Insulin and sulfonylureas were found to be associated with increased risk of potential overtreatment (p = 0.000, OR = 14.91 and p = 0.000, OR = 8.48, respectively) and reduced risk of potential undertreatment (p = 0.001, OR = 0.16 and p = 0.000, OR = 0.05, respectively), while DPP-4 inhibitors were found to be associated with reduced risk of potential undertreatment (p = 0.000, OR = 0.12).

Conclusion

Our study has shown that potential glycemic overtreatment and undertreatment are common problems in diabetic older adults. It was found that agents with a high risk of hypoglycemia, such as insulin and sulfonylureas, were more closely associated with potential overtreatment. In the management of diabetes in the elderly, it should be aimed to choose treatment agents that lead to less negative consequences and to follow up the patients more closely.

KEYWORDS:

• Diabetes mellitus
• older adults
• overtreatment
• undertreatment

Informed consent

Informed consent was taken.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval for the study was granted by Gaziantep University Medical Faculty Ethics Committee (no. 2020/115 dated 27.05.2020).

Disclosure statement

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.