Reactions Weekly | 2021
Adverse events with overtreatment in older adults with diabetes
Abstract
According to study results reported in Diabetologia, there is a risk of serious adverse events when older adults are over-treated with antihyperglycaemic agents, especially when high-risk agents are used for treatment to intensive glycaemic targets. The population-based cohort study included 108 620 community-dwelling patients ≥75 years of age in Ontario. Patients who had a prescription dispensed for at least one antihyperglycaemic agent between September 2014 and August 2015 were included. Glycaemic control was categorised as intensive or conservative (HbA1c <55 or 54–69 mmol/mol, respectively). The proportion of patients with intensive glycaemic control was 61.1% (21.6% with high-risk antihyperglycaemic agents, like insulin and sulfonylureas, and 39.5% with low-risk agents), and the proportion of patients with conservative control was 38.9% (23.7% with high-risk agents and 15.2% with low-risk agents). The primary outcome was a composite of diabetes-related (including hypoglycaemia) emergency department visit or hospitalisation, or all-cause mortality, within 30 days of the index date, adjusted by inverse probability of treatment weighting (IPTW) with propensity scores. The proportion of patients who experienced the composite outcome was lowest for conservative control with low-risk agents (0.41%), with higher proportions for conservative control with high-risk agents (0.67%, relative risk [RR] 1.25; 95% CI 1.02, 1.52), intensive control with low-risk agents (0.42%; RR 1.48; 1.18, 1.85) and intensive control with high-risk agents (0.92%; RR 1.49; 1.08, 2.05). Clinical inertia once a treatment is started as well as a focus on standard glycaemic targets without adopting a personalised approach to treatment goals may be contributing to these trends , note the authors. They conclude that our findings underscore the need to re-evaluate glycaemic targets in older adults and to reconsider the use of antihyperglycaemic medications that may lead to hypoglycaemia, especially in the setting of intensive glycaemic control .