Diabetes, Metabolic Syndrome and Obesity (Oct 2019)
A Retrospective Time Trend Study Of Diabetes Overtreatment In Geriatric Patients
Abstract
Zyta Beata Wojszel,1,2 Agnieszka Kasiukiewicz1,2 1Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland; 2Department of Geriatrics, Hospital of the Ministry of Interior in Bialystok, Bialystok, PolandCorrespondence: Zyta Beata WojszelDepartment of Geriatrics, Medical University of Bialystok, Fabryczna street 27, Bialystok 15-471, PolandTel +48 85 8694 982Fax +48 85 8694974Email [email protected]: We assessed changes in diabetes mellitus (DM) overtreatment prevalence in geriatric patients that had taken place after the introduction of the rule of therapy individualization in the Polish diabetes treatment guidelines.Patients and methods: This time-trend assessment comprised two retrospective cross-sectional cohort studies of type 2 DM patients admitted to a geriatric ward in 2009–2010 (1st round) and in 2014–2015 (2nd round). A high-risk group was defined as patients on antihyperglycemic medications prior to admission, who were 80+ years old, diagnosed with dementia, end-stage renal disease, or had a history of macrovascular complications. The primary outcome measure was glycosylated A1C hemoglobin (HbA1C) ≤7.0% (53 mmol/mol).Results: 213 patients in the 1st round and 83 in the 2nd round were included. Groups did not differ in age, gender, health and functional characteristics. The percentage of dementia (36.1% versus 18.8%, P=0.002) and of the high-risk cases (79.3% versus 67.7%, P=0.05) was higher in the 2nd round of the study. During the study, tight glycemic control prevalence in the high-risk group decreased significantly from 73.1% to 58.5%, P=0.04 (odds ratio 0.68, 95% CI 0.47–0.97), and the median value of HbA1c increased significantly from 6.4%, IQR 5.7–7.3 (46 mmol/mol, IQR 39–56) to 6.7%, IQR 6.1–7.9 (50 mmol/mol, IQR 43–63), P=0.03.Conclusion: Despite the principle of individualization of DM therapy that was in force, after a five-year observation, the problem of DM overtreatment still concerned a large percentage of geriatric patients, although a positive trend was noted in this respect.Keywords: type 2 diabetes, older people, therapy individualization, glycosylated A1C hemoglobin, HbA1c, tight control
