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01.12.2012 | Original investigation | Ausgabe 1/2012 Open Access

Cardiovascular Diabetology 1/2012

Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia

Zeitschrift:
Cardiovascular Diabetology > Ausgabe 1/2012
Autoren:
Peter Bramlage, Anselm K Gitt, Christiane Binz, Michael Krekler, Evelin Deeg, Diethelm Tschöpe
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1475-2840-11-122) contains supplementary material, which is available to authorized users.

Competing interests

AKG, PB, ED and DT have received research support and honoraria for lectures from Bristol-Myers Squibb and AstraZeneca, the sponsors of the present registry. CB and MK are employees of the sponsors.

Authors’ contributions

AKG, PB, DT, CB, and MK have been deeply involved in the conception and design of the study. ED is responsible for the analysis of data. PB has drafted the manuscript and all other authors have been revising the article for important intellectual content. All authors read and approved the final manuscript.

Abstract

Background

We aimed at identifying variables predicting hypoglycemia in elderly type 2 diabetic patients and the relation to HbA1c values achieved.

Design

Prospective, observational registry in 3810 patients in primary care. Comparison of patients in different age tertiles: with an age < 60 (young, n=1,253), age 60 to < 70 (middle aged, n=1,184) to those ≥ 70 years (elderly, n=1,373). Odds Ratios (OR) with 95% confidence intervals (CI) were determined from univariable and multivariable regression analyses.

Results

Elderly patients had a later diabetes diagnosis, a longer diabetes duration, better glucose control and more frequent co-morbid disease conditions. Overall 10.7% of patients experienced any severity hypoglycemia within the last 12 months prior to inclusion. Higher rates of hypoglycemia were observed in the elderly than in the young after adjusting for differences in HbA1c, fasting and post-prandial blood glucose (OR 1.68; 95%CI 1.16-2.45). This was particularly true for hypoglycemic episodes without specific symptoms (OR 1.74; 95%CI 1.05-2.89). In a multivariate model stroke / transitory ischemic attack, the presence of heart failure, clinically relevant depression, sulfonylurea use and blood glucose self-measurement were associated with hypoglycemic events.

Conclusion

Elderly patients are at an increased risk of hypoglycemia even at comparable glycemic control. Therefore identified variables associated with hypoglycemia in the elderly such as heart failure, clinically relevant depression, the use of sulfonylurea help to optimize the balance between glucose control and low levels of hypoglycemia. Asymptomatic hypoglycemia should not be disregarded as irrelevant but considered as a sign of possible hypoglycemia associated autonomic failure.
Zusatzmaterial
Authors’ original file for figure 1
12933_2012_555_MOESM1_ESM.pdf
Authors’ original file for figure 2
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Authors’ original file for figure 3
12933_2012_555_MOESM3_ESM.ppt
Authors’ original file for figure 4
12933_2012_555_MOESM4_ESM.ppt
Literatur
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