Christiaens Antoine, Boureau Anne-Sophie, Guyomarch Béatrice, de Decker Laure, Boland Benoit, Hadjadj Samy, Cariou Bertrand
Fund for Scientific Research-FNRS, Brussels, Belgium.
Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
Diabetes Care. 2025 Jan 1;48(1):61-66. doi: 10.2337/dc24-1058.
To assess the accuracy of "diabetes overtreatment" proxy definitions in predicting hypoglycemia in older adults with type 2 diabetes (T2D).
Inclusion of patients from HYPOAGE cohort with insulin-treated T2D, aged ≥75 years, and using a continuous glycemic monitoring (CGM) device for 28 days. "Diabetes overtreatment" was defined as HbA1c <7.0% (fixed proxy definition) or as HbA1c <7.0%, 7.5%, and 8.0% according to patient's health status (individualized proxy definition). The primary outcome was time below range (TBR) ≥1%.
Of the 134 patients included (81.6 ± 5.4 years, 59% male), 25 (19%) and 53 (40%) were overtreated, based on fixed and individualized proxy definitions, respectively. CGM data showed TBR >1% in nearly all patients regardless of overtreatment status. Both proxy definitions had low sensitivity (20% [14; 29] and 41% [32; 50]) and accuracy (27% [20; 35] and 44% [35; 53]) in predicting hypoglycemia.
A revised definition of diabetes overtreatment is needed to better manage older insulin-treated patients and protect them from hypoglycemia.
评估“糖尿病过度治疗”替代定义在预测老年2型糖尿病（T2D）患者低血糖方面的准确性。
纳入HYPOAGE队列中年龄≥75岁、接受胰岛素治疗的T2D患者，并使用持续血糖监测（CGM）设备28天。“糖尿病过度治疗”定义为糖化血红蛋白（HbA1c）<7.0%（固定替代定义），或根据患者健康状况定义为HbA1c<7.0%、7.5%和8.0%（个体化替代定义）。主要结局为血糖低于范围（TBR）≥1%的时间。
纳入的134例患者（81.6±5.4岁，59%为男性）中，根据固定和个体化替代定义，分别有25例（19%）和53例（40%）被过度治疗。CGM数据显示，几乎所有患者无论过度治疗状态如何，TBR>1%。两种替代定义在预测低血糖方面的敏感性（分别为20%[14；29]和41%[32；50]）和准确性（分别为27%[20；35]和44%[35；53]）均较低。
需要修订糖尿病过度治疗的定义，以更好地管理老年胰岛素治疗患者并防止他们发生低血糖。
