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Potential overtreatment of diabetes common in veterans with dementia
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Overly intense diabetes treatment and use of medications that raise the potential risk of hypoglycemia were common in older veterans with diabetes and dementia, according to recent study findings published in Diabetes Care.
Carolyn T. Thorpe, PhD, MPH, of Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Pharmacy, and colleagues evaluated 15,880 veterans (99% men) aged at least 65 years with type 2 diabetes and dementia who were prescribed antidiabetic medication to determine prevalence and risk factors for tight glycemic control (HbA1c <7%), as well as use of medications that raise the risk for hypoglycemia (sulfonylureas and/or insulin).
Carolyn T. Thorpe
Current clinical practice guidelines recommend against tight glycemic control in older patients with serious comorbidities such as dementia, due to increased risk for hypoglycemia and reduced potential benefits. Despite these guidelines, 52% of participants had tight glycemic control, followed by moderate control (36%) and poor control (7%), whereas 5% did not have HbA1c monitored. The mean and median HbA1c value was 6.3% in the tight-control group.
In addition, approximately 75% of the tight glycemic group used a regimen including sulfonylurea (52%), insulin (18%) or both (5%), which may further raise their potential risk for hypoglycemia.
Older age and previous diagnosis with heart valve disease, chronic lung disease, weight loss or deficiency anemia were identified as risk factors for tight glycemic control, whereas previous diagnosis with congestive heart failure, renal failure or obesity reduced the odds of tight control.
“Our results suggest that many older diabetes patients with dementia are overtreated by having their HbA1c controlled to <7% and that the majority of such patients may have their risk of hypoglycemia exacerbated further by using sulfonylureas and insulin to maintain this tight glycemic control,” Thorpe told Endocrine Today. “Clinicians caring for older diabetes patients with dementia should review their glycemic targets and medications, and consider relaxing glycemic targets to more moderate levels (HbA1c 7% to 9%) and substituting sulfonylureas and insulin with agents conferring lower risk of hypoglycemia.” – by Amber Cox
For more information:
Carolyn T. Thorpe, PhD, MPH, can be reached at VA Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA 15240; email: ctthorpe@pitt.edu.
Disclosure: The study was funded in part by the Health Services Research and Development within the US Department of Veterans Affairs.
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