The rational treatment of diabetes mellitus in older adults: The adequacy of treatment decisions based on individualized glycemic targets in primary and tertiary care

Abstract

Objectives: To access the adequacy of treatment decisions in accordance with current recommendations for individualizing glycemic targets in primary and tertiary care.

Methods: This multicenter cross-sectional study was conducted with a cohort of older type 2 diabetes patients from southern Brazil. Inclusion criteria were age over 65 years, having a previous diagnosis of type 2 diabetes (according to ADA criteria) and having at least two consultations registered in the medical records within one year. The primary outcome was the adequacy of treatment decisions according to pre-established HbA1c targets, which was compared with the complexity of care. The ideal HbA1c targets were: (1) 7-7.5% for an estimated life expectancy >10 years; (2) 7.5-8% for a life expectancy of 5-10 years; (3) 8-8.5% for a life expectancy <5 years. For analysis, the chi-square test was used for categorical variables and the t-test was used for continuous variables.

Results: Overall, 49.1% and 50.3% of the patients in the primary and tertiary care groups, respectively, received inadequate management. In patients whose HbA1c level was over target, the treatment was intensified in 46.3% and 51.2% of the primary and tertiary care groups, respectively (p = 0.57). In patients whose HbA1c level was under target, treatment was de-intensified in 5.9% and 26.2% in the primary and tertiary care groups, respectively (p <0.01).

Conclusion: Treatment changes based on individualized glycemic targets do occur in a minority of patients, which reflects the need for new strategies to facilitate individualized treatment targets and optimize the treatment adequacy in older adults.

Keywords: Diabetes mellitus in older adults; Individualized glycemic targets; Primary care; Tertiary care; Treatment changes.