Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study

• Published in: Diabetes, metabolic syndrome and obesity Vol. 8; no. default; pp. 303 - 313
• Main Authors: Penfornis, Alfred, Fiquet, Béatrice, Blicklé, Jean Frédéric, Dejager, Sylvie
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2015; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Age; Care and treatment; Comorbidity; Diabetes; Drugs; Endocrinology; Family physicians; Hypoglycemia; Insulin; Kidney diseases; Metabolism; Older people; Original Research; Patients; Physicians; Population; Type 2 diabetes; Variables; France; United States > US; type 2 diabetes mellitus; elderly; overtreatment; hypoglycemia; sulfonylureas; renal impairment
• ISSN: 1178-7007; 1178-7007
• DOI: 10.2147/DMSO.S83897

Few data exist examining the management of elderly patients with type 2 diabetes mellitus and renal impairment (RI). This observational study assessed the therapeutic management of this fragile population. Cross-sectional study: data from 980 diabetic patients ≥75 years with renal disease are presented. Patients had a mean age of 81 years (range 75-101) with long-standing diabetes (15.4 years) often complicated (half with macrovascular disease). Mean estimated glomerular filtration rate was 43 mL/min/1.73 m(2) and 20% had severe RI. Mean hemoglobin A1c was 7.4%. Anti-diabetic therapy was oral based for 51% of patients (60% ≥2 oral anti-diabetic drugs [OAD]) and insulin based for 49% (combined with OAD in 59%). OAD included metformin (47%), sulfonylureas (26%), glinides (19%), and DPP-4 inhibitors (31%). Treatments were adjusted to increasing RI, with less use of metformin, sulfonylureas, and DPP-4 inhibitors, and more glinides and insulin in severe RI. In all, 579 (60%) of these elderly patients with comorbidities had hemoglobin A1c <7.5% (mean 6.7%) while being intensively treated: 69% under insulin-secretagogues and/or insulin, putting them at high risk for severe hypoglycemia. Only one-fourth were under oral monotherapy. In clinical practice, a substantial proportion of elderly patients may be overtreated. RI is insufficiently taken into account when prescribing OAD.