Potential Risk of Overtreatment in Patients with Type 2 Diabetes Aged 75 Years or Older: Data from a Population Database in Catalonia, Spain

Abstract

Aim: To assess the potential risk of overtreatment in patients with type 2 diabetes (T2DM) aged 75 years or older in primary care. Methods: Electronic health records retrieved from the SIDIAP database (Catalonia, Spain) in 2016. Variables: age, gender, body mass index, registered hypoglycemia, last HbA1c and glomerular filtration rates, and prescriptions for antidiabetic drugs. Potential overtreatment was defined as having HbA1c < 7% or HbA1c < 6.5% in older patients treated with insulin, sulfonylureas, or glinides. Results: From a total population of 138,374 T2DM patients aged 75 years or older, 123,515 had at least one HbA1c available. An HbA1c below 7.0% was present in 59.1% of patients, and below 6.5% in 37.7%. Overall, 23.0% of patients were treated with insulin, 17.8% with sulfonylureas, and 6.6% with glinides. Potential overtreatment (HbA1c < 7%) was suspected in 26.6% of patients treated with any high-risk drug, 47.8% with sulfonylureas, 43.5% with glinides, and 28.1% with insulin. Using the threshold of HbA1c < 6.5%, these figures were: 21.6%, 24.4%, 17.9%, and 12.3%, respectively. Conclusion: One in four older adults with T2DM treated with antidiabetic drugs associated with a high risk of hypoglycemia might be at risk of overtreatment. This risk is higher in those treated with sulfonylureas or glinides than with insulin.

Overtreatment and associated risk factors among multimorbid older patients with diabetes

“…The level of overtreatment of T2DM in our study is comparable to recent studies also having documented a higher proportion of overtreatment than undertreatment 7,9,10,15,16 . A US study using Medicare data found that 11% of patients 65 years and older with T2DM were overtreated, and deintensification of overtreatment by reducing therapy took place only in about 14% 10,17 .…”

“…A strength of the present study is the focus on multimorbid older patients with polypharmacy, a population commonly excluded from trials, including large studies on T2DM, 2,19 but evaluated in larger observational studies in this context before 7–9 . In addition, the inclusion of OPERAM patients allowed consideration of multiple relevant covariates in the treatment of T2DM, including patient‐relevant outcomes 11,20 .…”

“…The American Geriatrics Society issued recommendations with its Choosing Wisely campaign to reduce overtreatment of T2DM in older patients defining metformin as the sole GLM appropriate to achieve hemoglobin A 1c (HbA 1c ) levels <7.5% 4–6 . Overtreatment of patients with T2DM has been evaluated both in North America 7,8 and Europe 9 . However, no study so far has assessed prevalence of T2DM overtreatment in multimorbid older patients by applying the American Geriatrics Society's Choosing Wisely definition of T2DM overtreatment, to the best of our knowledge.…”

“…However, no study so far has assessed prevalence of T2DM overtreatment in multimorbid older patients by applying the American Geriatrics Society's Choosing Wisely definition of T2DM overtreatment, to the best of our knowledge. Only few multicountry studies within different healthcare systems assessed overtreatment of T2DM in multimorbid older patients 7,9,10 . Furthermore, there is a lack of information on potential risk factors associated with overtreatment of T2DM focusing on these most vulnerable older adults, with high levels of comorbidities and polypharmacy 11 .…”

“…[4][5][6] Overtreatment of patients with T2DM has been evaluated both in North America 7,8 and Europe. 9 However, no study so far has assessed prevalence of T2DM overtreatment in multimorbid older patients by applying the American Geriatrics Society's Choosing Wisely definition of T2DM overtreatment, to the best of our knowledge. Only few multicountry studies within different healthcare systems assessed overtreatment of T2DM in multimorbid older patients.…”