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Large discrepancy in glycaemic control appropriateness in geriatric patients with type 2 diabetes according to major clinical practice guidelines

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Key summary points

AbstractSection Aim

This study compared glycaemic control appropriateness across three major clinical practice guidelines

AbstractSection Findings

Large discrepancy exists in glucose-lowering appropriateness classification between clinical practice guidelines, particularly in overtreatment detection.

AbstractSection Message

This finding relates to the absence in the clinical practice guidelines from the American Diabetes Association 2021 of a lower HbA1c value, which may be an obstacle to the prevention of hypoglycaemia.

Abstract

Purpose

In geriatric patients with type 2 diabetes (T2D), appropriate glycaemic control is crucial to avoid overtreatment and hypoglycaemia. This study compared glycaemic control appropriateness across three major clinical practice guidelines (CPGs).

Methods

Retrospective study of geriatric older inpatients with T2D and glucose-lowering treatment before admission. Patients were classified as appropriately treated, overtreated or undertreated using CPGs from Diabetes Canada 2018 (DC18), the Endocrine Society 2019 (ES19) and the American Diabetes Association 2021 (ADA21).

Results

Of the 318 geriatric patients (median age 84 years, 54% women, 66% in poor health), 46%, 25% and 82% were appropriately treated, while 38%, 57% and 0% were overtreated, based on DC18, ES19 and ADA21, respectively.

Conclusion

Large discrepancy of glycaemic control appropriateness was detected across these CPGs and concerned mainly overtreatment. This finding relates to the absence in ADA21 of a lower HbA1c value, which may be an obstacle to the prevention of hypoglycaemia.

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Fig. 1

Availability of data and materials

The datasets generated and analysed during the current study are not publicly available due to restrictions on patients’ anonymity but are available from the corresponding author on reasonable request.

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Funding

This study was supported by a Research Fellow grant [Antoine Christiaens] from the Fund for Scientific Research – FNRS (Belgium). The funding body (Fund for Scientific Research – FNRS, FC23595) played no part in the design of the study and collection, analysis, interpretation of data or in writing the manuscript.

Author information

Authors and Affiliations

  1. Fund for Scientific Research – FNRS, Brussels, Belgium

    Antoine Christiaens

  2. Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium

    Antoine Christiaens & Séverine Henrard

  3. Institute of Health and Society (IRSS), Université catholique de Louvain, 30, Clos Chapelle-Aux-Champs bte B1.30.15, 1200, Brussels, Belgium

    Antoine Christiaens, Séverine Henrard & Benoit Boland

  4. Geriatric Medicine, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

    Benoit Boland

Authors
  1. Antoine Christiaens
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  2. Séverine Henrard
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  3. Benoit Boland
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Contributions

AC designed the study, performed the analysis and interpreted the data under the supervision of SH and BB. AC drafted the manuscript, which was reviewed by SH and BB. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Antoine Christiaens.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board Committee (Commission d’Ethique Hospitalo-Facultaire, Cliniques universitaires Saint-Luc, Brussels, Belgium, IRB Agreement Nb. IRB00001530).

Informed consent

Not applicable.

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Christiaens, A., Henrard, S. & Boland, B. Large discrepancy in glycaemic control appropriateness in geriatric patients with type 2 diabetes according to major clinical practice guidelines. Eur Geriatr Med 13, 753–758 (2022). https://doi.org/10.1007/s41999-021-00594-1

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  • DOI: https://doi.org/10.1007/s41999-021-00594-1

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