Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study
Authors Penfornis A, Fiquet B, Blicklé JF, Dejager S
Received 3 March 2015
Accepted for publication 29 April 2015
Published 3 July 2015 Volume 2015:8 Pages 303—313
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 4
Editor who approved publication: Professor Ming-Hui Zou
Alfred Penfornis,1 Béatrice Fiquet,2 Jean Frédéric Blicklé,3 Sylvie Dejager2,4
1Department of Endocrinology and Diabetology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes Cedex, France; 2Clinical Affairs, Novartis Pharma SAS, Rueil-Malmaison, France; 3Department of Internal Medicine and Diabetology, Strasbourg University Hospital, Strasbourg, France; 4Department of Diabetology, Metabolism and Endocrinology, Pitié-Salpétrière Hospital, Paris, France
Background: 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.
Methods: Cross-sectional study: data from 980 diabetic patients ≥75 years with renal disease are presented.
Results: 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 m2 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.
Conclusion: In clinical practice, a substantial proportion of elderly patients may be overtreated. RI is insufficiently taken into account when prescribing OAD.
Keywords: elderly, hypoglycemia, overtreatment, renal impairment, sulfonylureas, type 2 diabetes mellitus
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]