Sarah Casagrande1, Catherine C Cowie2, Judith E Fradkin3. 1. Social & Scientific Systems, Inc., 8757 Georgia Ave., Silver Spring, MD, USA, 20910. Electronic address: scasagrande@s-3.com. 2. National Institute of Diabetes and Digestive and Kidney Diseases, 6707 Democracy Blvd, Bethesda, MD, USA 20892. Electronic address: cowie@nih.gov. 3. National Institute of Diabetes and Digestive and Kidney Diseases, 6707 Democracy Blvd, Bethesda, MD, USA 20892. Electronic address: Judith.Fradkin@nih.hhs.gov.
Abstract
AIMS: To determine the extent to which older vs. younger adults with diabetes intensively control glycemia. METHODS: Participants were age≥40years who self-reported a physician diagnosis of diabetes in the 2009-2014 National Health and Nutrition Examination Surveys (N=1554). Intensive glycemic control was defined as A1c<7.0% and taking insulin, sulfonylureas, or ≥2 glycemic medications. Logistic regression was used to determine the adjusted odds of intensive control in older (≥65years) vs. younger adults (age 40-64years). RESULTS: The prevalence of intensive control was greater for older (33.4%) vs. younger (21.3%) adults (p<0.001). In logistic regression, intensive control was significantly higher in older vs. younger adults after fully adjusting for sociodemographics, diabetes duration, comorbidities, disability, use of multiple medications, and depression (OR=1.72, 1.09-2.69). The multivariable adjusted prevalence of intensive control was 40% higher in adults ≥75years (35.6%) compared to adults 40-49years (21.7%). CONCLUSIONS: Older adults are being treated more aggressively than younger adults to achieve A1c<7.0% despite the presence of comorbidities, duration of diabetes, disability, and depression. Glycemic guidelines for individualized therapy are not being widely followed.
AIMS: To determine the extent to which older vs. younger adults with diabetes intensively control glycemia. METHODS:Participants were age≥40years who self-reported a physician diagnosis of diabetes in the 2009-2014 National Health and Nutrition Examination Surveys (N=1554). Intensive glycemic control was defined as A1c<7.0% and taking insulin, sulfonylureas, or ≥2 glycemic medications. Logistic regression was used to determine the adjusted odds of intensive control in older (≥65years) vs. younger adults (age 40-64years). RESULTS: The prevalence of intensive control was greater for older (33.4%) vs. younger (21.3%) adults (p<0.001). In logistic regression, intensive control was significantly higher in older vs. younger adults after fully adjusting for sociodemographics, diabetes duration, comorbidities, disability, use of multiple medications, and depression (OR=1.72, 1.09-2.69). The multivariable adjusted prevalence of intensive control was 40% higher in adults ≥75years (35.6%) compared to adults 40-49years (21.7%). CONCLUSIONS: Older adults are being treated more aggressively than younger adults to achieve A1c<7.0% despite the presence of comorbidities, duration of diabetes, disability, and depression. Glycemic guidelines for individualized therapy are not being widely followed.
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