Skip to main content
Erschienen in: The journal of nutrition, health & aging 10/2017

17.01.2017

Inadequate glycaemic control and therapeutic management of adults over 65 years old with type 2 diabetes mellitus in Spain

verfasst von: Francesc Formiga, J. Franch-Nadal, L. Rodriguez, L. Ávila, E. Fuster

Erschienen in: The journal of nutrition, health & aging | Ausgabe 10/2017

Einloggen, um Zugang zu erhalten

Abstract

Objectives

The glycaemic goals for older patients with type 2 diabetes mellitus (DM) are recommended to avoid an HbA1c levels <7%. The purpose of this study was to analyse the glycaemic control and therapeutic management of older adults (≥65 years) with type 2 DM.

Design

Pooled analysis of patients enrolled in three Spanish cross-sectional epidemiological studies.

Setting

The study was conducted between 2009 and 2011 by primary care or specialist physicians.

Participants

A total of 7,269 patients aged ≥65 years with type 2 DM.

Measurements

Sociodemographic, medical history, lifestyle habits, biochemical laboratory parameters, comorbidities, type 2 DM complications, and pharmacological treatment data collected from medical records.

Results

In total, data from 7,269 patients were analysed (mean age 73.4 years old; 48.4% male). A total of 10.9% of patients had HbA1c levels ≥8.5% and 43.2% <7%. The most common comorbidities were hypertension (82.0%) and dyslipidaemia (76.6%). The microvascular complications were mainly diabetic nephropathy (23.6%) and retinopathy (19.3%). Oral antidiabetic drugs (OADs) were taken by 70.5% of patients (sulphonylureas 65.3%), 4.1% were taking insulin alone and 25.4% took both insulin and an OAD. Half of the patients (51.0%) were taking a combination of OADs.

Conclusion

In conclusion, more than half of older patients with type 2 DM had unsatisfactory management: approximately one in ten had inadequate glycaemic control (HbA1c ≥8.5%) despite hypoglycaemic drugs and four in ten were potentially overtreated (HbA1c <7%).
Literatur
1.
Zurück zum Zitat IDF Global Guideline for Managing Older People with Type 2 Diabetes. In: Int. Diabetes Fed. https://www.idf.org/guidelines/managing-older-people-type-2-diabetes. Accessed 10 May 2016 IDF Global Guideline for Managing Older People with Type 2 Diabetes. In: Int. Diabetes Fed. https://​www.​idf.​org/​guidelines/​managing-older-people-type-2-diabetes.​ Accessed 10 May 2016
2.
Zurück zum Zitat Sinclair AJ, Paolisso G, Castro M, et al. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab 2011;37 Suppl 3:S27–38. doi: 10.1016/S1262-3636(11)70962-4CrossRefPubMed Sinclair AJ, Paolisso G, Castro M, et al. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab 2011;37 Suppl 3:S27–38. doi: 10.1016/S1262-3636(11)70962-4CrossRefPubMed
4.
Zurück zum Zitat Gómez Huelgas R, Díez-Espino J, Formiga F, et al. [Treatment of type 2 diabetes in the elderly]. Med Clínica 2013;140:134.e1-134.e12. doi: 10.1016/j. medcli.2012.10.003 Gómez Huelgas R, Díez-Espino J, Formiga F, et al. [Treatment of type 2 diabetes in the elderly]. Med Clínica 2013;140:134.e1-134.e12. doi: 10.1016/j. medcli.2012.10.003
5.
Zurück zum Zitat Dunning T, Sinclair A, Colagiuri S. New IDF Guideline for managing type 2 diabetes in older people. Diabetes Res Clin Pract 2014;103:538–540. doi: 10.1016/j.diabres.2014.03.005CrossRefPubMed Dunning T, Sinclair A, Colagiuri S. New IDF Guideline for managing type 2 diabetes in older people. Diabetes Res Clin Pract 2014;103:538–540. doi: 10.1016/j.diabres.2014.03.005CrossRefPubMed
6.
Zurück zum Zitat Bramlage P, Gitt AK, Binz C, et al. Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia. Cardiovasc Diabetol 2012;11:122. doi: 10.1186/1475-2840-11-122CrossRefPubMedPubMedCentral Bramlage P, Gitt AK, Binz C, et al. Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia. Cardiovasc Diabetol 2012;11:122. doi: 10.1186/1475-2840-11-122CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Du Y-F, Ou H-Y, Beverly EA, Chiu C-J. Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options. Clin Interv Aging 2014;9:1963–1980. doi: 10.2147/CIA.S53482PubMedPubMedCentral Du Y-F, Ou H-Y, Beverly EA, Chiu C-J. Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options. Clin Interv Aging 2014;9:1963–1980. doi: 10.2147/CIA.S53482PubMedPubMedCentral
8.
Zurück zum Zitat Lipska KJ, Ross JS, Miao Y, et al. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med 2015;175:356–362. doi: 10.1001/jamainternmed.2014.7345CrossRefPubMedPubMedCentral Lipska KJ, Ross JS, Miao Y, et al. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med 2015;175:356–362. doi: 10.1001/jamainternmed.2014.7345CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Font B, Lahoz R, Roldan C, et al. DB3 How a Fear of Hypoglycemia Influences Health-Related Quality of Life in Type 2 Diabetes Mellitus Patients in Spain? Hipoqol-II Study. Value Health 2012;15:A277. doi: 10.1016/j.jval.2012.08.470CrossRef Font B, Lahoz R, Roldan C, et al. DB3 How a Fear of Hypoglycemia Influences Health-Related Quality of Life in Type 2 Diabetes Mellitus Patients in Spain? Hipoqol-II Study. Value Health 2012;15:A277. doi: 10.1016/j.jval.2012.08.470CrossRef
10.
Zurück zum Zitat Gomis R, Artola S, Conthe P, et al. Prevalencia en consultas de diabetes mellitus tipo 2 en pacientes con sobrepeso u obesidad en España. Estudio OBEDIA. Med Clínica 2014;142:485–492. doi: 10.1016/j.medcli.2013.03.013CrossRef Gomis R, Artola S, Conthe P, et al. Prevalencia en consultas de diabetes mellitus tipo 2 en pacientes con sobrepeso u obesidad en España. Estudio OBEDIA. Med Clínica 2014;142:485–492. doi: 10.1016/j.medcli.2013.03.013CrossRef
11.
Zurück zum Zitat Javier Escalada F, Ezkurra P, Ferrer JC, et al. Análisis sobre los motivos de derivación de pacientes con diabetes mellitus tipo 2 entre atención primaria y atención especializada. Estudio Pathways. Av En Diabetol 2013;29:60–67. doi: 10.1016/j.avdiab.2013.03.001CrossRef Javier Escalada F, Ezkurra P, Ferrer JC, et al. Análisis sobre los motivos de derivación de pacientes con diabetes mellitus tipo 2 entre atención primaria y atención especializada. Estudio Pathways. Av En Diabetol 2013;29:60–67. doi: 10.1016/j.avdiab.2013.03.001CrossRef
12.
Zurück zum Zitat Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461–470. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461–470.
13.
Zurück zum Zitat Finucane TE. “Tight control” in geriatrics: the emperor wears a thong. J Am Geriatr Soc 2012;60:1571–1575. doi: 10.1111/j.1532-5415.2012.04057.xCrossRefPubMed Finucane TE. “Tight control” in geriatrics: the emperor wears a thong. J Am Geriatr Soc 2012;60:1571–1575. doi: 10.1111/j.1532-5415.2012.04057.xCrossRefPubMed
14.
Zurück zum Zitat Sinclair A, Dunning T, Rodriguez-Mañas L. Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol 2015;3:275–285. doi: 10.1016/S2213-8587(14)70176-7CrossRefPubMed Sinclair A, Dunning T, Rodriguez-Mañas L. Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol 2015;3:275–285. doi: 10.1016/S2213-8587(14)70176-7CrossRefPubMed
15.
Zurück zum Zitat Barrot-de la Puente J, Mata-Cases M, Franch-Nadal J, et al. Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database. Int J Clin Pract 2015;69:1486–1495. doi: 10.1111/ijcp.12741CrossRefPubMedPubMedCentral Barrot-de la Puente J, Mata-Cases M, Franch-Nadal J, et al. Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database. Int J Clin Pract 2015;69:1486–1495. doi: 10.1111/ijcp.12741CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Bouillet B, Vaillant G, Petit J-M, et al. Are elderly patients with diabetes being overtreated in French long-term-care homes? Diabetes Metab 2010;36:272–277. doi: 10.1016/j.diabet.2010.01.009CrossRefPubMed Bouillet B, Vaillant G, Petit J-M, et al. Are elderly patients with diabetes being overtreated in French long-term-care homes? Diabetes Metab 2010;36:272–277. doi: 10.1016/j.diabet.2010.01.009CrossRefPubMed
17.
Zurück zum Zitat Kim KS, Kim SK, Sung KM, et al. Management of type 2 diabetes mellitus in older adults. Diabetes Metab J 2012;36:336–344. doi: 10.4093/dmj.2012.36.5.336CrossRefPubMedPubMedCentral Kim KS, Kim SK, Sung KM, et al. Management of type 2 diabetes mellitus in older adults. Diabetes Metab J 2012;36:336–344. doi: 10.4093/dmj.2012.36.5.336CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Fu H, Curtis BH, Schuster DP, et al. Treatment patterns among older patients with type 2 diabetes in the United States: a retrospective cohort study. Diabetes Technol Ther 2014;16:833–839. doi: 10.1089/dia.2014.0039CrossRefPubMed Fu H, Curtis BH, Schuster DP, et al. Treatment patterns among older patients with type 2 diabetes in the United States: a retrospective cohort study. Diabetes Technol Ther 2014;16:833–839. doi: 10.1089/dia.2014.0039CrossRefPubMed
19.
Zurück zum Zitat Souza JG, Apolinario D, Magaldi RM, et al. Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study. BMJ Open 2014;4:e004180. doi: 10.1136/bmjopen-2013-004180CrossRefPubMedPubMedCentral Souza JG, Apolinario D, Magaldi RM, et al. Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study. BMJ Open 2014;4:e004180. doi: 10.1136/bmjopen-2013-004180CrossRefPubMedPubMedCentral
Metadaten
Titel
Inadequate glycaemic control and therapeutic management of adults over 65 years old with type 2 diabetes mellitus in Spain
verfasst von
Francesc Formiga
J. Franch-Nadal
L. Rodriguez
L. Ávila
E. Fuster
Publikationsdatum
17.01.2017
Verlag
Springer Paris
Erschienen in
The journal of nutrition, health & aging / Ausgabe 10/2017
Print ISSN: 1279-7707
Elektronische ISSN: 1760-4788
DOI
https://doi.org/10.1007/s12603-017-0869-4

Weitere Artikel der Ausgabe 10/2017

The journal of nutrition, health & aging 10/2017 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.