Background: The 2019 Endocrine Society guidelines for treatment of diabetes in older people define individualised HbA1c targets for glucose-lowering therapy (GLT) in older people with type 2 diabetes (T2D) according to their health status. Our study assessed the association between GLT appropriateness according to these guidelines (appropriate, overuse, underuse) and one-year mortality.
Methods: Retrospective study of all inpatients ≥75 years with T2D and GLT admitted to a geriatric ward of an academic hospital (Brussels) between 2008-2015. Factors associated with one-year mortality were tested in multivariable Cox proportional hazards regression.
Results: Among the 318 patients (84 years; 54% women), GLT overuse was detected in 57.2% and underuse in 17.9%. In multivariable analysis, one-year mortality was associated with poor health (HR: 1.59, p=0.033) and GLT overuse (HR: 1.73, p=0.023). One-year survival was the highest in patients in intermediate health with appropriate GLT and the lowest in those in poor health with GLT overuse (Figure 1; one-year survival [95%CI]: 0.87 [0.76-1.00] and 0.53 [0.45-0.62], respectively).
Conclusion: GLT overuse and poor health status are independent predictors of one-year mortality in geriatric patients with type 2 diabetes. As many of these patients met these two conditions, there is room to improve GLT individualisation and deprescribing.
A. Christiaens: None. B.J. Boland: None. S. Henrard: None.
Fund for Scientific Research (FC23595)