Overtreatment of older patients with type 2 diabetes mellitus in primary care

Huberta E Hart, Guy E Rutten, Kyra N Bontje, Rimke C Vos

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Given that there are indications of overtreatment in older patients with type 2 diabetes in both the United States and Europe, we assessed the level of personalized diabetes treatment for older patients in primary care, focusing on overtreatment. Based on Dutch guidelines individuals aged ≥70years were classified into 3 glycated haemoglobin (HbA1c) treatment target groups: 7% (53mmol/mol), 7.5% (58mmol/mol) and 8% (64mmol/mol). In our cohort of 1002 patients (n=319 aged ≥70years), the 165 patients with HbA1c targets >7% had more micro- and macrovascular complications, more often used ≥5 medicines and were more often frail compared with those with an HbA1c target ≤7%. Of these 165 patients, 64 (38.8%) were overtreated; that is, 20% of all people aged ≥70years. The majority of overtreated people were frail and used ≥5 medicines. Hypoglycaemia occurred in 20.3% of these patients and almost 30% reported accidents involving falls. Personalized treatment in older people with type 2 diabetes is not common practice. A substantial number of older people are overtreated, with probable harmful consequences. To prevent overtreatment, definition of lower HbA1c limits might be helpful.

Original languageEnglish
Pages (from-to)1066-1069
Number of pages4
JournalDiabetes, Obesity & Metabolism
Volume20
Issue number4
Early online date24 Jan 2018
DOIs
Publication statusPublished - Apr 2018

Keywords

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Diabetes Mellitus, Type 2/blood
  • Female
  • Glycated Hemoglobin A/analysis
  • Humans
  • Hypoglycemic Agents/therapeutic use
  • Male
  • Medical Overuse/statistics & numerical data
  • Middle Aged
  • Netherlands
  • Practice Patterns, Physicians'/statistics & numerical data
  • Primary Health Care/statistics & numerical data

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