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Erschienen in: Diabetologia 5/2021

25.01.2021 | Article

Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study

verfasst von: Iliana C. Lega, Michael A. Campitelli, Peter C. Austin, Yingbo Na, Afshan Zahedi, Freda Leung, Catherine Yu, Susan E. Bronskill, Paula A. Rochon, Lorraine L. Lipscombe

Erschienen in: Diabetologia | Ausgabe 5/2021

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Abstract

Aims/hypothesis

More than 25% of older adults (age ≥75 years) have diabetes and may be at risk of adverse events related to treatment. The aim of this study was to assess the prevalence of intensive glycaemic control in this group, potential overtreatment among older adults and the impact of overtreatment on the risk of serious events.

Methods

We conducted a retrospective, population-based cohort study of community-dwelling older adults in Ontario using administrative data. Participants were ≥75 years of age with diagnosed diabetes treated with at least one anti-hyperglycaemic agent between 2014 and 2015. Individuals were categorised as having intensive or conservative glycaemic control (HbA1c <53 mmol/mol [<7%] or 54–69 mmol/mol [7.1–8.5%], respectively), and as undergoing treatment with high-risk (i.e. insulin, sulfonylureas) or low-risk (other) agents. We measured the composite risk of emergency department visits, hospitalisations, or death within 30 days of reaching intensive glycaemic control with high-risk agents.

Results

Among 108,620 older adults with diagnosed diabetes in Ontario, the mean (± SD) age was 80.6 (±4.5) years, 49.7% were female, and mean (± SD) diabetes duration was 13.7 (±6.3) years. Overall, 61% of individuals were treated to intensive glycaemic control and 21.6% were treated to intensive control using high-risk agents. Using inverse probability treatment weighting with propensity scores, intensive control with high-risk agents was associated with nearly 50% increased risk of the composite outcome compared with conservative glycaemic control with low-risk agents (RR 1.49, 95% CI 1.08, 2.05).

Conclusions/interpretation

Our findings underscore the need to re-evaluate glycaemic targets in older adults and to reconsider the use of anti-hyperglycaemic medications that may lead to hypoglycaemia, especially in setting of intensive glycaemic control.

Graphical abstract

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Metadaten
Titel
Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study
verfasst von
Iliana C. Lega
Michael A. Campitelli
Peter C. Austin
Yingbo Na
Afshan Zahedi
Freda Leung
Catherine Yu
Susan E. Bronskill
Paula A. Rochon
Lorraine L. Lipscombe
Publikationsdatum
25.01.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Diabetologia / Ausgabe 5/2021
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-020-05370-7

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