Are older patients with diabetes still being overtreated in French long-term care homes?

Quilot, Emilienne; Petit, Jean‐Michel; Vergès, Bruno; Bouillet, Benjamin

doi:10.1093/ageing/afaa051

Cited by 5 publications

(3 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, 2 definitions took only HbA 1c values into account, 28,29,31,40 4 definitions required the use of any GL agent(s) 22,23,25,27,34 and 2 definitions required the use of a GLT inducing a high risk of hypoglycaemia, i.e. a GLT including insulin, sulfonylurea or a glinide 15,20,24,30,32,35,37–39 . The HbA 1c threshold considered by the different definitions varied from <42 mmol/mol (6.0%) to <58 mmol/mol (7.5%).…”

Section: Resultsmentioning

confidence: 99%

“…HbA 1c < 53 mmol/mol (7.0%) for all patients 20,24,30,32,35,37,38 HbA 1c < 58 mmol/mol (7.5%) for all patients…”

Section: Discussionmentioning

confidence: 99%

“…a GLT including insulin, sulfonylurea or a glinide. 15,20,24,30,32,35,[37][38][39] The HbA 1c threshold considered by the different definitions varied from <42 mmol/mol (6.0%) to <58 mmol/mol (7.5%).…”

Section: Definitions Of Overtreatmentmentioning

confidence: 99%

See 2 more Smart Citations

Overtreatment of older people with type 2 diabetes—a high impact frequent occurrence in need of a new definition

et al. 2022

View full text Add to dashboard Cite

Background Diabetes overtreatment is a frequent and major issue in older people with type 2 diabetes but its definition is often inconsistent and may be misleading. This critical review has aimed at examining the definitions of diabetes overtreatment in older people used in research studies. Methods Studies addressing diabetes overtreatment in people aged 65 or older were identified by searching the PubMed database according to an extensive search equation. Results Twenty‐two research studies providing a definition of diabetes overtreatment in people aged were found. Overall, 12 different definitions of diabetes overtreatment were used. All studies defined overtreatment according to a HbA1c threshold (varying from <42 mmol/mol [<6.0%] to <64 mmol/mol [<8%]). Amongst them, 2 definitions had no consideration about glucose‐lowering (GL) treatment, 6 required the prescribing of ≥1 GL agent(s), and 4 the prescribing of ≥1 GL agent(s) inducing the high risk of hypoglycaemia (i.e., sulfonylurea(s) or insulin(s)). Only 4 definitions (four studies) were individualised, using varying HbA1c thresholds according to patients' age or health status. Conclusions Definitions of diabetes overtreatment are heterogeneous across research studies, which is confusing. A standardised definition, based on the individual risk of hypoglycaemia and/or its complications must be promoted in order to bring clarity and greater insight into this field, as well as to improve the quality of management of diabetes in older patients.

show abstract

Section: Resultsmentioning

confidence: 99%

“…HbA 1c < 53 mmol/mol (7.0%) for all patients 20,24,30,32,35,37,38 HbA 1c < 58 mmol/mol (7.5%) for all patients…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Overtreatment of older people with type 2 diabetes—a high impact frequent occurrence in need of a new definition

et al. 2022

View full text Add to dashboard Cite

show abstract

Potential Overtreatment and Undertreatment of Type 2 Diabetes Mellitus in Long-Term Care Facilities: A Systematic Review

Stasinopoulos

Wood

Bell

et al. 2021

Journal of the American Medical Directors Association

View full text Add to dashboard Cite

Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes

et al. 2021

View full text Add to dashboard Cite

Background Little is known about the prevalence of hypoglycaemia in older people with diabetes. However, the HbA1c goal is ≥8% for institutionalised patients with treatments that can cause hypoglycaemia. Purpose We aimed to assess the prevalence of hypoglycaemia with continuous glucose monitoring and to evaluate the link with HbA1C in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs. Design Prospective, multicentre study carried out in six geriatric care centres in the Côte d’Or region of France between January 2019 and July 2020. Settings, subjects and methods A FreeStyle Libre Pro® (FSLP) was worn for up to 14 days in blinded mode in 42 patients taking at least one potentially hypoglycaemia-inducing antidiabetic drug. Results Two hundred and forty-two hypoglycaemic events were detected in 79% (n = 33) of patients wearing the FSLP. One or more hypoglycaemic event was detected in 100% of patients with HbA1C < 7% and in 79% of patients with HbA1C ≥ 8% (P = 0.02). The time spent in hypoglycaemia was higher in patients with HbA1C < 7% than those with HbA1C ≥ 8% (P = 0.015). Time spent <54 mg/dl was detected in 45% of patients. Conclusions We report a very high prevalence of hypoglycaemia, with a significant proportion of severe hypoglycaemia, in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs. Having HbA1C < 7% exposes patients to a higher risk of hypoglycaemia, but this risk remains also high in patients with HbA1C ≥ 8%. In this population, continuous glucose monitoring could be considered an effective tool to detect hypoglycemia, which is associated with increased risk of cardiovascular events, falling, fractures, cognitive impairment and mortality.

show abstract

Are older patients with diabetes still being overtreated in French long-term care homes?

Cited by 5 publications

References 12 publications

Overtreatment of older people with type 2 diabetes—a high impact frequent occurrence in need of a new definition

Overtreatment of older people with type 2 diabetes—a high impact frequent occurrence in need of a new definition

Potential Overtreatment and Undertreatment of Type 2 Diabetes Mellitus in Long-Term Care Facilities: A Systematic Review

Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes

Contact Info

Product

Resources

About