Older people with Type 2 diabetes, including those with chronic kidney disease or dementia, are commonly overtreated with sulfonylurea or insulin therapies

Abstract

In the present cohort of older people with Type 2 diabetes prescribed sulfonylurea or insulin therapies, overtreatment was common, even in the presence of comorbidities known to increase hypoglycaemia risk.

Deintensification in older patients with type 2 diabetes: A systematic review of approaches, rates and outcomes

“…A number of RCTs have shown that intensive glycaemic control directed at lower HbA1c targets is associated with only minor cardiovascular benefits, but increased adverse events such as mortality . Evidence shows that older people with type 2 diabetes and other comorbidities are being overtreated with drugs that cause hypoglycaemia . Hambling and colleagues observed that older people, including those with comorbidities such as CKD or dementia, were managed to similar intensive thresholds as those without CKD or dementia .…”

“…46 Evidence shows that older people with type 2 diabetes and other comorbidities are being overtreated with drugs that cause hypoglycaemia. [20][21][22]47 Hambling and colleagues observed that older people, including those with comorbidities such as CKD or dementia, were managed to similar intensive thresholds as those without CKD or dementia. 47 These older patients are especially vulnerable to hypoglycaemic episodes and other adverse events such as fractures, head injuries, CVD, or even death, 9,11,12 given predisposing factors such as advanced age, frailty, long duration of diabetes, polypharmacy, and comorbidities such as CKD and cognitive impairment.…”

“…[20][21][22]47 Hambling and colleagues observed that older people, including those with comorbidities such as CKD or dementia, were managed to similar intensive thresholds as those without CKD or dementia. 47 These older patients are especially vulnerable to hypoglycaemic episodes and other adverse events such as fractures, head injuries, CVD, or even death, 9,11,12 given predisposing factors such as advanced age, frailty, long duration of diabetes, polypharmacy, and comorbidities such as CKD and cognitive impairment. 9,15,48,49 Intensive treatment with antihyperglycaemic medication in these patients doubles the risk of hypoglycaemia.…”

The effects of hypoglycaemia and dementia on cardiovascular events, falls and fractures and all‐cause mortality in older individuals: A retrospective cohort study

“…3 Self-management of diabetes is particularly challenging for older patients because they have limited recall of the dangers of hypoglycaemia and what remedial action to take, 4 and because they are more prone to hypoglycaemia because of their medication. 5,6 The burden of hypoglycaemia in older patients has mounted steadily, [7][8][9] with one study reporting a 267% increase in hospitalizations for hypoglycaemia in patients aged 75 years or older in England and Wales (2000-2014) and a 10-fold higher admission rate compared to patients in the 15-59 years of age group. 7 A worldwide study of 109 countries revealed a 60% increase in hypoglycaemia-related deaths between 2000 and 2010, with these deaths occurring mainly in individuals over the age of 50 years.…”

Risk of hypoglycaemia in people aged ≥65 years receiving linagliptin: pooled data from 1489 individuals with type 2 diabetes mellitus

“…One of the major challenges facing current treatment strategies is that a substantial number of older patients with T2DM struggle to achieve even their less stringent individualised glycated haemoglobin (HbA1c) targets . Furthermore, many of these patients are on complex regimens that include insulin and/or a sulphonylurea (SU), drugs that increase the risk of hypoglycaemia . While metformin continues to be a first‐line medication in the treatment of T2DM, recent recommendations for the treatment of patients aged >65 years focus on regimens with either basal insulin, dipeptidyl peptidase‐4 (DPP‐4) inhibitors, or a combination of these …”