Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study

Figures & data

Figure 1 Flow chart of patients’ disposition.

Note: The red circles show the subgroup of patients from the OREDIA main study.
Abbreviations: CKD, chronic kidney disease; DBs, diabetologists; eGFR, estimated glomerular filtration rate; GPs, general practitioners; T2DM, type 2 diabetes mellitus.

Table 1 Demographic and disease characteristics according to physicians: whole population

	GPs N=771	DBs N=209	P-value GP vs DB	Total N=980
Age (years, mean ± SD)	80.7±4.4	80.7±3.9	0.849	80.7±4.3
Sex (% male)	55.8	55.0	0.832*	55.7
BMI (kg/m^2, mean ± SD)	28.6±4.8	29.2±4.7	0.128	28.7±4.8
Duration of T2DM (years, mean ± SD)	14.2±7.9	19.7±10.6	<0.001	15.4±8.8
% of patients with ≥15 years duration	46.4	66.0	<0.001*	50.6
HbA1c (%, mean ± SD)	7.3±1.0	7.8±1.2	<0.001	7.4±1.1
<7%, % of patients	40.1	21.5	<0.001*	36.1
7%–7.5%, % of patients	24.1	20.6		23.3
7.5%–8%, % of patients	14.9	23.4		16.7
≥8%, % of patients	20.9	34.4		23.8
At least one complication, % of patients	87.5	93.8	0.024**	88.9
Microvascular	78.3	90.0	<0.001*	80.8
Retinopathy	19.2	23.0	0.227*	20.0
Nephropathy	71.5	85.6	<0.001*	74.5
Neuropathy	15.0	31.1	<0.001*	18.5
Macrovascular	46.7	56.5	0.012*	48.8
Coronary heart disease	28.1	39.2	0.002*	30.5
Cerebrovascular disease	10.6	11.0	0.878*	10.7
Lower limb arteriopathy	19.7	22.5	0.377*	20.3
Symptomatic heart failure	23.2	10.5	<0.001*	20.5
At least one CV risk factor, % of patients	99.3	99.5	1.000**	99.4
Hypertension	95.5	97.1	0.285*	95.8
Dyslipidemia	75.2	86.6	0.001*	77.7
Sedentary lifestyle	53.4	47.8	0.151*	52.2
Management of CV risk
Number of co-medicationsa, mean ± SD	5.4±2.8	6.1±2.8	0.007	5.5±2.8
Lipid-lowering drugs, % of patients	71.7	84.7	<0.001*	74.5
Anti-platelet therapies, % of patients	64.3	66.5	0.559*	64.8
Anti-hypertensive treatments, % of patients	95.1	97.1	0.203*	95.5
≥3 Anti-hypertensive drugs, % of patients	40.1	51.7	0.003*	42.6
One/two RAAS blockers, % of patients	73.3/2.9	77.5/4.3	0.147*	74.2/3.2
eGFR (mL/min/1.73 m^2, mean ± SD)	43.1±17.4	41.3±14.0	0.117	42.7±16.8
<30, % of patients	20.1	17.7	0.378*	19.6
30–60, % of patients	69.9	74.6		70.9
≥60, % of patients	10.0	7.7		9.5
UAER, % of patientsb
Microalbuminuria	51.9	40.6	0.020*	49.2
Macroalbuminuria	27.8	29.7		28.3
Specialists’ involvement, % of patients
Diabetologist	42.3	100	<0.001*	54.6
Nephrologist	36.6	44.0	0.049*	38.2
Cardiologist	80.9	83.7	0.355*	81.5

Notes:

a Associated treatments for CV risk management, except anti-diabetic treatments;

b this information was available for 67% of the patients;

* chi-square test;

** Fisher’s test. N = the number of patients.

Abbreviations: BMI, body mass index; CV, cardiovascular; DB, diabetologist; eGFR, estimated glomerular filtration rate; GPs, general practitioners; HbA_1c, hemoglobin A_1c; RAAS, renin angiotensin aldosterone system; SD, standard deviation; T2DM, type 2 diabetes mellitus; UAER, urinary albumin excretion rate.

Figure 2 Therapeutic management of T2DM by eGFR status and by physicians.

Note: (A) GPs and (B) diabetologists.
Abbreviations: eGFR, estimated glomerular filtration rate; GPs, general practitioners; T2DM, type 2 diabetes mellitus.

Table 2 Demographic and disease characteristics according to physicians: patients with HbA_1c <7.5%

	GPs N=491	DBs N=88	P-value GP vs DB	Total N=579
Age (years, mean ± SD)	80.6±4.4	80.5±4.3	0.901	80.6±4.4
Sex (% male)	59.4	62.5	0.583*	59.9
BMI (kg/m^2, mean ± SD)	28.4±4.7	29.4±4.4	0.73	28.5±4.6
Duration of T2DM (years, mean ± SD)	13.4±7.9	20.5±10.6	<0.001	14.5±8.7
HbA1c (%, mean ± SD)	6.7±0.5	6.8±0.4	0.041	6.7±0.5
<7%, % of patients	62.5	51.1	0.044*	60.8
≥7 and <7.5%, % of patients	37.5	48.9		39.2
At least one complication, % of patients	85.5	95.5	0.028**	87.0
Microvascular	74.7	89.8	0.002*	77.0
Retinopathy	17.3	25.0	0.087*	18.5
Nephropathy	68.2	84.1	0.003*	70.6
Neuropathy	14.5	35.2	<0.001	17.6
Macrovascular	44.6	62.5	0.002*	47.3
Coronary heart disease	27.5	43.2	0.003*	29.9
Cerebrovascular disease	9.2	12.5	0.330*	9.7
Lower limb arteriopathy	18.9	25.0	0.190*	19.9
Symptomatic heart failure	22.6	13.6	0.058*	21.2
At least one CV risk factor, % of patients	99.2	100	1.000**	99.3
Hypertension	96.3	97.7	0.753**	96.5
Dyslipidemia	73.7	88.6	0.003*	76.0
Sedentary lifestyle	52.7	51.1	0.780*	52.5
Management of CV risk
Number of co-medicationsa, mean ± SD	5.4±3.0	6.9±3.2	<0.001	5.6±3.1
Lipid-lowering drugs, % of patients	69.7	87.5	0.001	72.4
Anti-platelet therapies, % of patients	62.1	71.6	0.089	63.6
Anti-hypertensive treatments, % of patients	95.9	97.7	0.555**	96.2
≥3 Anti-hypertensive drugs, % of patients	38.5	51.1	0.026*	40.4
One/two RAAS blockers, % of patients	72.7/3.3	76.1/3.4	0.767*	73.2/3.3
eGFR (mL/min/1.73 m^2, mean ± SD)	43.5±17.6	40.7±16.3	0.170	43.1±17.5
<30, % of patients	18.3	20.5	0.558*	18.7
30–60, % of patients	71.3	72.7		71.5
≥60, % of patients	10.4	6.8		9.8
UAER, % of patientsb
Microalbuminuria	49.5	39.1	0.070*	47.7
Macroalbuminuria	27.4	24.6		26.9
Specialists’ involvement, % of patients
Diabetologist	39.3	100	<0.001*	48.5
Nephrologist	37.1	47.7	0.059*	38.7
Cardiologist	80.2	86.4	0.176*	81.2

Notes:

a Associated treatments for CV risk management, except anti-diabetic treatments;

b this information was available for 67% of the patients;

* chi-square test;

** Fisher’s test. N = the number of patients.

Abbreviations: BMI, body mass index; CV, cardiovascular; DB, diabetologist; eGFR, estimated glomerular filtration rate; GPs, general practitioners; HbA_1c, hemoglobin A_1c; RAAS, renin angiotensin aldosterone system; SD, standard deviation; T2DM, type 2 diabetes mellitus; UAER, urinary albumin excretion rate.

Figure 3 Anti-diabetic treatment in patients with HbA_1c <7.5% (mean 6.7%).

Abbreviations: DBs, diabetologists; GPs, general practitioners; HbA_1c, hemoglobin A_1c; OAD, oral anti-diabetic drugs.