Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study.
Age Factors
Aged
Aged, 80 and over
Aging
/ blood
Cohort Studies
Diabetes Mellitus, Type 2
/ blood
Drug-Related Side Effects and Adverse Reactions
/ epidemiology
Female
Glycemic Control
/ adverse effects
History, 21st Century
Humans
Hypoglycemia
/ chemically induced
Hypoglycemic Agents
/ therapeutic use
Male
Ontario
/ epidemiology
Overtreatment
/ statistics & numerical data
Prevalence
Retrospective Studies
Risk Factors
Diabetes overtreatment
Healthcare delivery
Hypoglycaemia
Insulin secretagogues
Insulin therapy
Intensive glycaemic control
Older adults
Journal
Diabetologia
ISSN: 1432-0428
Titre abrégé: Diabetologia
Pays: Germany
ID NLM: 0006777
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
10
08
2020
accepted:
05
11
2020
pubmed:
26
1
2021
medline:
23
2
2022
entrez:
25
1
2021
Statut:
ppublish
Résumé
More than 25% of older adults (age ≥75 years) have diabetes and may be at risk of adverse events related to treatment. The aim of this study was to assess the prevalence of intensive glycaemic control in this group, potential overtreatment among older adults and the impact of overtreatment on the risk of serious events. We conducted a retrospective, population-based cohort study of community-dwelling older adults in Ontario using administrative data. Participants were ≥75 years of age with diagnosed diabetes treated with at least one anti-hyperglycaemic agent between 2014 and 2015. Individuals were categorised as having intensive or conservative glycaemic control (HbA Among 108,620 older adults with diagnosed diabetes in Ontario, the mean (± SD) age was 80.6 (±4.5) years, 49.7% were female, and mean (± SD) diabetes duration was 13.7 (±6.3) years. Overall, 61% of individuals were treated to intensive glycaemic control and 21.6% were treated to intensive control using high-risk agents. Using inverse probability treatment weighting with propensity scores, intensive control with high-risk agents was associated with nearly 50% increased risk of the composite outcome compared with conservative glycaemic control with low-risk agents (RR 1.49, 95% CI 1.08, 2.05). Our findings underscore the need to re-evaluate glycaemic targets in older adults and to reconsider the use of anti-hyperglycaemic medications that may lead to hypoglycaemia, especially in setting of intensive glycaemic control.
Identifiants
pubmed: 33491105
doi: 10.1007/s00125-020-05370-7
pii: 10.1007/s00125-020-05370-7
doi:
Substances chimiques
Hypoglycemic Agents
0
Types de publication
Historical Article
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1093-1102Subventions
Organisme : CIHR
ID : 1018890
Pays : Canada
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