Appropriateness of glucose-lowering therapy in geriatric patients with type 2 diabetes: factors associated with glucose-lowering therapy at high risk of hypoglycaemia.

Christiaens, Antoine;Germanidis, Marie;Henrard, Séverine;Boland, Benoît
(2019) Doctoral day – Thematic doctoral school SPSS 2019 — Location: Louvain-la-Neuve

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Authorship: CHRISTIAENS Antoinea,b,c, GERMANIDIS Maried, HENRARD Séverineb,c, BOLAND Benoîtb,d. a Fonds de la Recherche Scientifique (F.R.S.-FNRS); b Institute of Health and Society, UCLouvain; c Clinical Pharmacy Research Group, Louvain Drug Research Institute, UCLouvain; d Geriatric medicine unit, Cliniques universitaires Saint Luc; Brussels, Belgium. Introduction: In order to minimise the risk of hypoglycaemia, glucose-lowering therapy (GLT) should be prescribed carefully and adequately in geriatric patients with type 2 diabetes (T2D). This study aimed at assessing factors associated with GLT-overuse (i.e. high risk of hypoglycaemia (HRH)) in geriatric patients with T2D. Methods: Retrospective study of consecutive inpatients with T2D admitted to a geriatric ward of a university hospital (Brussels; 2008-2015). Inclusion criteria were age ≥75 years, T2D, non-diabetic multimorbidities ≥3, HbA1c measurement and a GLT. GLT agents were divided into hypoglycaemic (sulfonylureas, glinides, insulins) and non-hypoglycaemic agents. GLT-appropriateness was defined according to the new Guidelines on Diabetes management in older adults (1). Pearson’s χ² test and Wilcoxon-Mann-Whitney test were used to compare 2 groups. A multivariable logistic regression was used to assess factors associated with HRH. Conditions of validity of each analysis were fulfilled. Results: Among the 318 geriatric patients with T2D included (median age: 84 years; 54% women), 105 (33.0%) were in intermediate health and 213 (67.0%) in poor health. No significant difference in HbA1c value was found between the 2 groups (median HbA1c value: 6.9%). GLT-overuse (i.e. with HRH) was present in 182 patients (57.2%). HRH was associated in multivariable model with poor health status (OR=1.66, p=0.045), severe kidney failure with glomerular filtration rate (eGFR) lower than 30ml/min (OR=2.05, p=0.034) and atrial fibrillation (OR = 2.15; p=0.003). In addition, patients with HRH had a higher one-year mortality rate than the other ones (44.5% vs. 29.6%, p=0.023). Discussion - Conclusions: In clinical practice, there is a room for improvement, as more than 1 out of 2 geriatric patients with T2D in our study had a high risk of hypoglycaemia due to inappropriate GLT prescription, according to the newest guidelines on therapeutic management of T2D in older adults. In particular, special attention should be paid to geriatric patients with poor health, severe kidney failure (eGFR<30ml/min) or atrial fibrillation, as these conditions were associated with GLT-overuse.
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Christiaens, A., Germanidis, M., Henrard, S., & Boland, B. (2019). Appropriateness of glucose-lowering therapy in geriatric patients with type 2 diabetes: factors associated with glucose-lowering therapy at high risk of hypoglycaemia. Doctoral day – Thematic doctoral school SPSS 2019, Louvain-la-Neuve. https://hdl.handle.net/2078.5/216150