OBJECTIVE

To assess the accuracy of “diabetes overtreatment” proxy definitions in predicting hypoglycemia in older adults with type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS

Inclusion of patients from HYPOAGE cohort with insulin-treated T2D, aged ≥75 years, and using a continuous glycemic monitoring (CGM) device for 28 days. “Diabetes overtreatment” was defined as HbA1c < 7.0% (fixed proxy definition) or as HbA1c < 7.0%, 7.5% and 8.0% according to patient’s health status (individualized proxy definition). The primary outcome was time below range (TBR) ≥ 1%.

RESULTS

Of the 134 patients included (81.6 ± 5.4 years, 59% male), 25 (19%) and 53 (40%) were overtreated, based on fixed and individualized proxy definitions, respectively. CGM data showed TBR >1% in nearly all patients regardless of overtreatment status. Both proxy definitions had low sensitivity (20% [14%; 29%] and 41% [32%; 50%]) and accuracy (27% [20%; 35%] and 44% [35%; 53%]) in predicting hypoglycemia.

CONCLUSIONS

A revised definition of diabetes overtreatment is needed to better manage older insulin-treated patients and protect them from hypoglycemia.

Graphical Abstract

graphic
View largeDownload slide

This article contains supplementary material online at https://doi.org/10.2337/figshare.26524384.

This content is only available via PDF.
© 2024 by the American Diabetes Association
2024
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/journals/pages/license.
You do not currently have access to this content.