Comparing real-world Type 2 diabetes management with the Francophone Diabetes Society’s recommendations:  using comprehensive geriatric assessment-guided medication reviews of frail older adults living with comorbid diabetes and cancer

Abstract

Purpose: Substantial clinical heterogeneity in older adults with diabetes makes therapeutic management challenging. This study compared real-world type 2 diabetes management of older outpatients who had comorbid cancer with published guidelines in order to identify the circumstances in which antidiabetic treatment de-intensification might be appropriate. Methods: We retrospectively analysed data from comprehensive geriatric assessment-guided medication reviews of all outpatients with comorbid diabetes referred to our geriatric oncology day hospital unit in 2022-2023. Results: Of the 738 outpatients who had a medication review, 190 had comorbid diabetes; mean age was 79.5 ± 5.6 years. Despite the high prevalence of frailties and geriatric syndromes observed, the mean HbA1c level was low (6.89% ± 1.03%). Two-thirds (63.5%) of participants had an HbA1c outside the recommended individual target range. Of these, 80% had an HbA1c below the range, suggesting overtreatment. Sulfonylureas and glinides accounted for 18.4% and 11.6% of antidiabetic prescriptions, respectively. A total of 170 diabetes-related therapeutic issues were identified in 67.9% of patients. Having an HbA1c below the individual target range (p < 0.001) and receiving at least three prescribed antidiabetic drugs (p< 0.05) were both significantly associated with having at least one diabetes-related therapeutic issue. Conclusion: Our study revealed overly aggressive glycaemic control in this frail older population of patients with comorbid cancer and diabetes and highlights poor clinical adherence to official guidelines. Geriatrician-pharmacist collaborations could provide a more comprehensive understanding of patients’ health status and functional category profiles and improve the therapeutic management of older patients with diabetes.