Nicolle Müller1, Kamlesh Khunti2, Oliver Kuss3,4, Ulf Lindblad5, John J Nolan6, Guy Ehm Rutten7, Marina Trento8, Massimo Porta8, Johannes Roth9, Guillaume Charpentier10, Viktor Jörgens11, Ulrich A Müller9. 1. Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany. nicolle.mueller@med.uni-jena.de. 2. Department of Health Sciences, University of Leicester, Leicester, UK. 3. Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany. 4. German Center for Diabetes Research (DZD), 85764, München-Neuherberg, Germany. 5. Department of Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden. 6. Steno Diabetes Center, Gentofte, Denmark. 7. Department of General Practice, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands. 8. Department of Medical Sciences, University of Turin, Turin, Italy. 9. Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany. 10. Corbeil-Essonnes Hospital, Corbeil-Essonnes, France. 11. EASD 1988-2015, Düsseldorf, Germany.
Abstract
AIMS: We used data from the GUIDANCE Study to determine the care of people with type 2 diabetes according to age and accompanying cardiovascular diseases and to assess indicators of overtreatment of glycaemia. METHODS: The GUIDANCE study was a retrospective, cross-sectional study from 2009-2010 based on the records of 7597 people in France, Belgium, Italy, the Netherlands, Sweden, UK, Ireland and Germany. We analysed the level of metabolic control achieved and blood glucose-lowering medication used in different age groups and in relation to accompanying diseases. RESULTS: 4.459 patients (59.1%) were 65 years or older. Their HbA1c levels were similar to those with <65 years. 44.7% of patients ≥65 years had an HbA1c ≤7% (53 mmol/mol) and were treated with insulin or sulfonylureas, and 27.1% of them had ischaemic heart disease or congestive heart failure. Significantly more patients with heart disease had HbA1c values ≤7% (53 mmol/mol) and were treated more often with insulin or sulfonylureas compared to patients of the same age without heart disease. CONCLUSIONS: Most patients were treated according to guidelines valid at the time this large international patient sample was surveyed. Older and younger patients were at a similar level of metabolic control, and almost half of the patients with an age of ≥65 years and treated with insulin or sulfonylurea had HbA1c levels below the target range (≤7%) for younger patients. However, these patients have an increased risk of severe hypoglycaemic events with potentially dangerous complications, particularly in those with cardiovascular diseases.
AIMS: We used data from the GUIDANCE Study to determine the care of people with type 2 diabetes according to age and accompanying cardiovascular diseases and to assess indicators of overtreatment of glycaemia. METHODS: The GUIDANCE study was a retrospective, cross-sectional study from 2009-2010 based on the records of 7597 people in France, Belgium, Italy, the Netherlands, Sweden, UK, Ireland and Germany. We analysed the level of metabolic control achieved and blood glucose-lowering medication used in different age groups and in relation to accompanying diseases. RESULTS: 4.459 patients (59.1%) were 65 years or older. Their HbA1c levels were similar to those with <65 years. 44.7% of patients ≥65 years had an HbA1c ≤7% (53 mmol/mol) and were treated with insulin or sulfonylureas, and 27.1% of them had ischaemic heart disease or congestive heart failure. Significantly more patients with heart disease had HbA1c values ≤7% (53 mmol/mol) and were treated more often with insulin or sulfonylureas compared to patients of the same age without heart disease. CONCLUSIONS: Most patients were treated according to guidelines valid at the time this large international patient sample was surveyed. Older and younger patients were at a similar level of metabolic control, and almost half of the patients with an age of ≥65 years and treated with insulin or sulfonylurea had HbA1c levels below the target range (≤7%) for younger patients. However, these patients have an increased risk of severe hypoglycaemic events with potentially dangerous complications, particularly in those with cardiovascular diseases.
Entities:
Keywords:
HbA1c; Hypoglycaemia; Overtreatment; Type 2 diabetes
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