Individualizing treatment targets for elderly patients with type 2 diabetes: factors influencing clinical decision making in the 24-week, randomized INTERVAL study

Abstract

We tested the feasibility of setting individualized glycemic goals and factors influencing targets set in a clinical trial in elderly patients with type 2 diabetes.A 24-week, randomized, double-blind, placebo-controlled study was conducted in 45 outpatient centers in seven European countries. 278 drug-naïve or inadequately controlled (mean HbA1c 7.9%) patients with type 2 diabetes aged ≥70 years with HbA1c levels ≥7.0% and ≤10.0% were enrolled. Investigator-defined individualized HbA1c targets and the impact of baseline characteristics on individualized treatment targets was evaluated.The average individualized HbA1c target was set at 7.0%. HbA1c at baseline predicted a target setting such that higher the HbA1c, more aggressive was the target (P<0.001). Men were more likely to be set aggressive targets than women (P=0.026). Frailty status of patients showed a trend towards significance (P=0.068), whereas diabetes duration, age, or polypharmacy did not. There was heterogeneity between countries regarding how baseline factors were viewed.Despite training and guidance to individualize HbA1c goals, targets were still set in line with conventional values. A strong influence of country-specific guidelines on target setting was observed; confirming the importance of further education to implement new international guidelines in older adults.

The impact of cardiovascular co-morbidities and duration of diabetes on the association between microvascular function and glycaemic control

“…To date, however, only one study has even attempted to demonstrate the feasibility of individualising care [ 23 ]. Whilst the INTERVAL study demonstrated that achieving individualised glycaemic targets was feasible, process of setting such targets themselves was very difficult [ 24 ].…”

Dipeptidyl Peptidase-4 Inhibitor Development and Post-authorisation Programme for Vildagliptin – Clinical Evidence for Optimised Management of Chronic Diseases Beyond Type 2 Diabetes

“… 45 Surprisingly, men were set more aggressive targets than women (p=0.026; Figure 2 ), whereas setting targets according to the frailty status demonstrated only a trend towards significance (p=0.068). 46 In non-frail patients, the baseline weight predicted a less aggressive glycaemic target setting (p=0.012), while astonishingly, glycaemic targets were not adjusted according to the body weight in frail patients (p=0.725; Figure 3 ). 46 …”

Innovations in personalised diabetes care and risk management

“…Later it was concluded that despite extensive training and guidance the physicians in the study did not differ from the traditional glycaemic settings and therefore did not personalise the treatment strategy. 56 The MID FRAIL study recently compared a modular intervention consisting of education, exercise and personalised metabolic targets against usual care in frail people with T2D of 70 years and older, and this was the first study to show positive functional outcomes after one year which were cost-effective. 57 In summary, it is generally accepted that metabolic control in older people should be relaxed in phase with increasing multimorbidity and frailty.…”