Poor health status, inappropriate glucose-lowering therapy and high one-year mortality in geriatric patients with type 2 diabetes

BMC Geriatrics

Séverine Henrard¹  Olivia Dalleur²  Antoine Christiaens³  Marie Germanidis⁴  Benoit Boland⁵ 

[1] Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium;Institute of Health and Society (IRSS), Université catholique de Louvain, 30, Clos Chapelle-Aux-Champs bte B1.30.15, 1200, Brussels, Belgium;Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium;Pharmacy Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium;Fund for Scientific Research – FNRS, Brussels, Belgium;Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium;Institute of Health and Society (IRSS), Université catholique de Louvain, 30, Clos Chapelle-Aux-Champs bte B1.30.15, 1200, Brussels, Belgium;Geriatric Medicine Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium;Institute of Health and Society (IRSS), Université catholique de Louvain, 30, Clos Chapelle-Aux-Champs bte B1.30.15, 1200, Brussels, Belgium;Geriatric Medicine Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium;

关键词: Geriatric patients;    Health status;    Mortality;    Type 2 diabetes;    Glucose-lowering therapy;    Overtreatment;   

DOI  :  10.1186/s12877-020-01780-9

来源: Springer

【 摘 要 】

BackgroundGlucose-lowering therapy (GLT) should be individualized in older patients with type 2 diabetes (T2D) according to their health status and their life expectancy. This study aimed at assessing the inappropriateness of GLT prescribing and the one-year mortality rate in geriatric patients with T2D.MethodsRetrospective cohort study of consecutive inpatients with T2D admitted to a geriatric ward of a Belgian university hospital. Inclusion criteria were age ≥ 75 years, T2D with GLT before admission, and HbA1c measurement during the hospital stay. Comorbidities and geriatric syndromes were collected. GLT agents were classified into hypoglycaemic and non-hypoglycaemic ones, and their dosages were expressed in daily defined dose (DDD). Health status (intermediate or poor) and GLT appropriateness (appropriate, overtreatment, undertreatment) were assessed according to the 2019 Endocrine Society guideline on diabetes treatment in older adults, in which GLT overtreatment requires the presence of hypoglycaemic therapy. One-year mortality was determined using the National Registry of vital status, and its associated factors were analysed using multivariable Cox’ regression.ResultsThe 318 geriatric patients with T2D (median age 84 years; 46% female) were in intermediate (33%) or poor health (67%). These two groups reached similar low HbA1c values (median 6.9%) with similar GLT regimens. GLT overtreatment was frequent (57%) irrespectively of the geriatric features. One-year mortality rate was high (38.5%) and associated in multivariate analysis with poor health status (HR: 1.59, p = 0.033), malnutrition (HR: 1.67, p = 0.006) and GLT overtreatment (HR: 1.73, p = 0.023). Patients with GLT overtreatment had a higher mortality rate (44.5%).ConclusionsGLT overtreatment was present in more than half of these geriatric patients. Many of them were in poor health status and died within one-year. Special attention should be paid to individualisation of the HbA1c goals in the geriatric patients with diabetes, and to GLT de-intensification in those being over-treated.

【 授权许可】

CC BY