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NHANES: More aggressive treatment observed in older vs. younger adults with diabetes
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Older adults with type 2 diabetes are more likely to be treated with intensive glycemic control — defined as therapy with two antidiabetes agents with an HbA1c goal of 7% of lower — than younger adults with the disease, despite the increased risk for hypoglycemia with advanced age, according to an analysis of National Health and Nutrition Examination Survey data.
“We found that, regardless of demographics, duration of diabetes, comorbidities and other diabetes-related factors, older adults were more likely to have intensive glycemic control compared to their younger counterparts,” Sarah Casagrande, PhD, a senior research analyst with Social and Scientific Systems Inc. in Silver Spring, Maryland, and colleagues wrote. “Moreover, there was roughly a 40% increase in the adjusted prevalence of intensive glycemic control for adults aged [at least] 75 years vs. age 40 to 49 years. Thus, despite treatment recommendations by the [American Diabetes Association] and [American Geriatrics Society], which endorse less stringent goals for patients with shorter life expectancy and comorbidities, older adults are being treated more aggressively than younger adults.”
Casagrande and colleagues analyzed data from 1,554 adults with type 2 diabetes aged at least 40 years participating in NHANES between 2009 and 2014. Participants self-reported comorbidities, disability status and use of prescription medications in the last 30 days, and completed the Patient Health Questionnaire. Intensive control of diabetes was defined as an HbA1c of 7% or lower and the use of sulfonylureas, insulin or at least two antidiabetes medications. Researchers used logistic regression analysis to determine the odds of younger vs. older adults having intensive control of diabetes.
Within the cohort, 55.2% were aged 40 to 64 years; 44.8% were aged at least 65 years; 48.8% were women; 61.4% were white.
Researchers observed a higher prevalence of intensive diabetes control among adults aged at least 65 years vs. those aged 40 to 64 years (P < .001); this higher prevalence was also observed in older adults with comorbidities vs. adults aged 40 to 64 years with comorbidities (P = .018).
After adjusting for demographics, diabetes duration, smoking status, comorbidities, disability, use of multiple medications and depression, older adults were markedly more likely to receive intensive diabetes control vs. adults aged 40 to 65 years (OR = 1.72; 95% CI, 1.09-2.69). Prevalence of intensive control increased with increasing age, according to the researchers. Prevalence was 21.7% for adults aged 40 to 49 years, 23.5% for those aged 50 to 64 years, 32.5% for adults aged 65 to 74 years and 35.6% for those aged at least 75 years.
“Guidelines for glycemic control call for individualized targets that weigh the risks and benefits of intensive therapy,” Casagrande told Endocrine Today. “However, we found that older adults, despite comorbidities, were treated more aggressively than younger adults with agents that carry the risk of hypoglycemia. This suggests that the guidelines for individualized therapy are not being widely followed. Future research is needed to understand why clinicians and/or patients may not follow the guidelines.”– by Regina Schaffer
Disclosure: The National Institute of Diabetes and Digestive and Kidney Diseases funded the research. The researchers report no relevant financial disclosures.
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