Overtreatment of type 2 diabetes is common and potentially harmful in older adults, according to a primary care study in Diabetes, Obesity and Metabolism.
The observational study included 1002 patients being treated for type 2 diabetes at five Dutch primary care centers, including 319 patients aged 70 years or older. These older patients were classified into subgroups according to Dutch guidelines, based on glycated hemoglobin targets: 7%, 7.5%, and 8%. Levels of personalized care for type 2 diabetes were assessed, focusing on overtreatment.
The analysis identified 165 patients aged 70 or older with an HbA1c target of greater than 7%. In this group, 54.0% of patients had microvascular complications, compared to 35.2% of those with lower HbA1c targets. Rates of macrovascular complications were 33.3% versus 17.7%, respectively. Patients with higher HbA1c targets were almost more likely to use five or more medications and more likely to be frail.
Of the 165 patients, 64 were overtreated: a rate of 38.8%, or 20% of all patients aged 70 years or older. Most overtreated patients were frail and used five or more medications. About 20% had episodes of hypoglycemia, while nearly 30% had accidents involving falls.
For patients with type 2 diabetes aged 70 or older, the risk of harm associated with HbA1c targets under the conventional 7% seem to outweigh the benefits. There are indications of overtreatment in this group of patients in the United States as well as Europe. In the Netherlands, more than 85% of patients with type 2 diabetes are managed in primary care.
The new study suggests that many older adults with type 2 diabetes are overtreated, with probable harmful consequences. “Personalized treatment in older people with type 2 diabetes is not common practice,” the researchers write. They suggest that guidelines defining a lower HbA1c limit might be helpful to prevent overtreatment [Hart HE, et al. Overtreatment of older patients with type 2 diabetes mellitus in primary care. Diabetes Obes Metab 2017; DOI: 10.1111/dom.13174].