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Is there evidence of potential overtreatment of glycaemia in elderly people with type 2 diabetes? Data from the GUIDANCE study

Acta Diabetologica volume 54, pages 209–214 (2017)Cite this article

Abstract

Aims

We used data from the GUIDANCE Study to determine the care of people with type 2 diabetes according to age and accompanying cardiovascular diseases and to assess indicators of overtreatment of glycaemia.

Methods

The GUIDANCE study was a retrospective, cross-sectional study from 2009–2010 based on the records of 7597 people in France, Belgium, Italy, the Netherlands, Sweden, UK, Ireland and Germany. We analysed the level of metabolic control achieved and blood glucose-lowering medication used in different age groups and in relation to accompanying diseases.

Results

4.459 patients (59.1%) were 65 years or older. Their HbA1c levels were similar to those with <65 years. 44.7% of patients ≥65 years had an HbA1c ≤7% (53 mmol/mol) and were treated with insulin or sulfonylureas, and 27.1% of them had ischaemic heart disease or congestive heart failure. Significantly more patients with heart disease had HbA1c values ≤7% (53 mmol/mol) and were treated more often with insulin or sulfonylureas compared to patients of the same age without heart disease.

Conclusions

Most patients were treated according to guidelines valid at the time this large international patient sample was surveyed. Older and younger patients were at a similar level of metabolic control, and almost half of the patients with an age of ≥65 years and treated with insulin or sulfonylurea had HbA1c levels below the target range (≤7%) for younger patients. However, these patients have an increased risk of severe hypoglycaemic events with potentially dangerous complications, particularly in those with cardiovascular diseases.

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Acknowledgements

KK acknowledges the support from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care—East Midlands (NIHR CLAHRC—EM), the Leicester Clinical Trials Unit and the NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit. KK has acted as a consultant and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme. He has received grants in support of investigator and investigator initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. KK has received funds for research, honoraria for speaking at meetings and has served on advisory boards for Lilly, Sanofi-Aventis, Merck Sharp & Dohme and Novo Nordisk.

Author Contribution

NM researched data and wrote the manuscript, KK reviewed/edited the manuscript and contributed to the discussion, OK researched data and reviewed/edited the manuscript, UL reviewed/edited the manuscript and contributed to the discussion, and JN reviewed/edited the manuscript and contributed to the discussion. GR reviewed/edited the manuscript and contributed to the discussion, MT reviewed/edited the manuscript and contributed to the discussion, MP reviewed/edited the manuscript and contributed to the discussion, JR contributed to the discussion, GC reviewed/edited the manuscript, VJ reviewed/edited the manuscript and contributed to the discussion, and UAM had the research idea, contributed to the discussion and reviewed/edited the manuscript.

Funding

The GUIDANCE study was funded by the European Association for the Study of Diabetes from a grant from Merck & Co. (Whitehouse Station, NJ). Merck scientists participated in the initial conceptualisation and protocol development but were not involved in the conduct of the study or in the analysis and interpretation of the data collected. The present analysis was funded by the Diabetes Centre Thuringia, Germany, a non-profit-making organisation for diabetes education and research.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany

    Nicolle Müller, Johannes Roth & Ulrich A. Müller

  2. Department of Health Sciences, University of Leicester, Leicester, UK

    Kamlesh Khunti

  3. Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany

    Oliver Kuss

  4. German Center for Diabetes Research (DZD), 85764, München-Neuherberg, Germany

    Oliver Kuss

  5. Department of Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden

    Ulf Lindblad

  6. Steno Diabetes Center, Gentofte, Denmark

    John J. Nolan

  7. Department of General Practice, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands

    Guy EHM Rutten

  8. Department of Medical Sciences, University of Turin, Turin, Italy

    Marina Trento & Massimo Porta

  9. Corbeil-Essonnes Hospital, Corbeil-Essonnes, France

    Guillaume Charpentier

  10. EASD 1988-2015, Düsseldorf, Germany

    Viktor Jörgens

Authors
  1. Nicolle Müller
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  2. Kamlesh Khunti
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  3. Oliver Kuss
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  4. Ulf Lindblad
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  5. John J. Nolan
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  6. Guy EHM Rutten
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  7. Marina Trento
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  8. Massimo Porta
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  9. Johannes Roth
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  10. Guillaume Charpentier
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  11. Viktor Jörgens
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  12. Ulrich A. Müller
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Corresponding author

Correspondence to Nicolle Müller.

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Conflict of interest

No other potential conflicts of interest relevant to this article were reported.

Ethical standard

The responsible Ethics Committee in each country had given approval.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed consent

Informed consent was obtained from all patients for being included in the study.

Additional information

Managed by Antonio Secchi.

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Müller, N., Khunti, K., Kuss, O. et al. Is there evidence of potential overtreatment of glycaemia in elderly people with type 2 diabetes? Data from the GUIDANCE study. Acta Diabetol 54, 209–214 (2017). https://doi.org/10.1007/s00592-016-0939-9

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  • DOI: https://doi.org/10.1007/s00592-016-0939-9

Keywords

  • Type 2 diabetes
  • HbA1c
  • Hypoglycaemia
  • Overtreatment