A Retrospective Time Trend Study Of Diabetes Overtreatment In Geriatric Patients
Received 1 July 2019
Accepted for publication 13 September 2019
Published 4 October 2019 Volume 2019:12 Pages 2023—2032
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Antonio Brunetti
Zyta Beata Wojszel,1,2 Agnieszka Kasiukiewicz1,2
1Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland; 2Department of Geriatrics, Hospital of the Ministry of Interior in Bialystok, Bialystok, Poland
Correspondence: Zyta Beata Wojszel
Department of Geriatrics, Medical University of Bialystok, Fabryczna street 27, Bialystok 15-471, Poland
Tel +48 85 8694 982
Fax +48 85 8694974
Purpose: We assessed changes in diabetes mellitus (DM) overtreatment prevalence in geriatric patients that had taken place after the introduction of the rule of therapy individualization in the Polish diabetes treatment guidelines.
Patients and methods: This time-trend assessment comprised two retrospective cross-sectional cohort studies of type 2 DM patients admitted to a geriatric ward in 2009–2010 (1st round) and in 2014–2015 (2nd round). A high-risk group was defined as patients on antihyperglycemic medications prior to admission, who were 80+ years old, diagnosed with dementia, end-stage renal disease, or had a history of macrovascular complications. The primary outcome measure was glycosylated A1C hemoglobin (HbA1C) ≤7.0% (53 mmol/mol).
Results: 213 patients in the 1st round and 83 in the 2nd round were included. Groups did not differ in age, gender, health and functional characteristics. The percentage of dementia (36.1% versus 18.8%, P=0.002) and of the high-risk cases (79.3% versus 67.7%, P=0.05) was higher in the 2nd round of the study. During the study, tight glycemic control prevalence in the high-risk group decreased significantly from 73.1% to 58.5%, P=0.04 (odds ratio 0.68, 95% CI 0.47–0.97), and the median value of HbA1c increased significantly from 6.4%, IQR 5.7–7.3 (46 mmol/mol, IQR 39–56) to 6.7%, IQR 6.1–7.9 (50 mmol/mol, IQR 43–63), P=0.03.
Conclusion: Despite the principle of individualization of DM therapy that was in force, after a five-year observation, the problem of DM overtreatment still concerned a large percentage of geriatric patients, although a positive trend was noted in this respect.
Keywords: type 2 diabetes, older people, therapy individualization, glycosylated A1C hemoglobin, HbA1c, tight control
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