Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Diabetologia. 2021 May;64(5):1093-1102. doi: 10.1007/s00125-020-05370-7. Epub 2021 Jan 25.
AIMS/HYPOTHESIS: More than 25% of older adults (age ≥75 years) have diabetes and may be at risk of adverse events related to treatment. The aim of this study was to assess the prevalence of intensive glycaemic control in this group, potential overtreatment among older adults and the impact of overtreatment on the risk of serious events.
We conducted a retrospective, population-based cohort study of community-dwelling older adults in Ontario using administrative data. Participants were ≥75 years of age with diagnosed diabetes treated with at least one anti-hyperglycaemic agent between 2014 and 2015. Individuals were categorised as having intensive or conservative glycaemic control (HbA <53 mmol/mol [<7%] or 54-69 mmol/mol [7.1-8.5%], respectively), and as undergoing treatment with high-risk (i.e. insulin, sulfonylureas) or low-risk (other) agents. We measured the composite risk of emergency department visits, hospitalisations, or death within 30 days of reaching intensive glycaemic control with high-risk agents.
Among 108,620 older adults with diagnosed diabetes in Ontario, the mean (± SD) age was 80.6 (±4.5) years, 49.7% were female, and mean (± SD) diabetes duration was 13.7 (±6.3) years. Overall, 61% of individuals were treated to intensive glycaemic control and 21.6% were treated to intensive control using high-risk agents. Using inverse probability treatment weighting with propensity scores, intensive control with high-risk agents was associated with nearly 50% increased risk of the composite outcome compared with conservative glycaemic control with low-risk agents (RR 1.49, 95% CI 1.08, 2.05).
CONCLUSIONS/INTERPRETATION: Our findings underscore the need to re-evaluate glycaemic targets in older adults and to reconsider the use of anti-hyperglycaemic medications that may lead to hypoglycaemia, especially in setting of intensive glycaemic control.
目的/假设：超过 25%的老年人（年龄≥75 岁）患有糖尿病，并且可能存在与治疗相关的不良事件风险。本研究旨在评估这一人群强化血糖控制的流行率、老年人中潜在的过度治疗以及过度治疗对严重事件风险的影响。
我们使用行政数据对安大略省的社区居住老年人进行了回顾性、基于人群的队列研究。参与者年龄≥75 岁，在 2014 年至 2015 年期间至少使用一种抗高血糖药物治疗糖尿病。个体被分为强化或保守血糖控制（HbA<53mmol/mol[<7%]或 54-69mmol/mol[7.1-8.5%]），并接受高风险（即胰岛素、磺脲类药物）或低风险（其他）药物治疗。我们测量了在使用高风险药物达到强化血糖控制后 30 天内急诊就诊、住院或死亡的复合风险。
在安大略省诊断患有糖尿病的 108620 名老年人中，平均（±标准差）年龄为 80.6（±4.5）岁，49.7%为女性，平均（±标准差）糖尿病病程为 13.7（±6.3）年。总体而言，61%的患者接受强化血糖控制治疗，21.6%的患者接受高风险药物强化血糖控制治疗。使用倾向评分逆概率治疗加权法，与低风险药物保守血糖控制相比，高风险药物强化血糖控制与复合结局风险增加近 50%相关（RR 1.49，95%CI 1.08，2.05）。
结论/解释：我们的研究结果强调了需要重新评估老年人的血糖目标，并重新考虑使用可能导致低血糖的抗高血糖药物，特别是在强化血糖控制的情况下。
