One-quarter of older U.S. adults may be overtreated for diabetes

Suzanne V. Arnold, M.D., from the University of Missouri-Kansas City, and colleagues examined the proportion of older adults with diabetes mellitus treated with tight glucose control and the factors associated with this practice. Data were obtained from 42,669 adults aged 75 and older with type 2 diabetes mellitus seen at 151 outpatient sites participating in the Diabetes Collaborative Registry. Patients were categorized according to glycosylated hemoglobin (HbA1c) and glucose-lowering medications. Groups were defined as poor control (HbA1c >9 percent), moderate control (HbA1c 8 to 9 percent), conservative control (HbA1c 7 to 8 percent), tight control with low-risk agents for hypoglycemia (HbA1c <7 percent), or tight control with high-risk agents. Another group was classified as diet control (HbA1c <7 percent taking no glucose-lowering medications).

Based on the 30,696 participants without diet-controlled diabetes, the researchers found that 18 percent had moderate or poor control, 30 percent had conservative control, 26 percent had tight control taking low-risk agents, and 26 percent had tight control taking high-risk agents. Factors independently associated with greater odds of tight control with high-risk agents included older age, male sex, heart failure, chronic kidney disease, and coronary artery disease. The aggressiveness of patient management was similar across practice specialty (endocrinology, primary care, and cardiology).

“These results suggest potential overtreatment of a substantial proportion of people and should encourage further efforts to translate guidelines to daily practice,” the authors write.

The Diabetes Collaborative Registry is funded by AstraZeneca and Boehringer Ingelheim. Several authors disclosed financial ties to these companies.