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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 anonymous peer review

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

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