Diabetes Overtreatment and Hypoglycemia in Older Patients With Type 2 Diabetes on Insulin Therapy: Insights From the HYPOAGE Cohort Study

Abstract

Objective: To assess the accuracy of "diabetes overtreatment" proxy definitions in predicting hypoglycemia in older adults with type 2 diabetes (T2D).

Research design and methods: 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%.

Results: 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.

Conclusions: A revised definition of diabetes overtreatment is needed to better manage older insulin-treated patients and protect them from hypoglycemia.