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Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control
Open accessAbstract
IMPORTANCE: In older adults with multiple serious comorbidities and functional limitations, the harms of intensive glycemic control likely exceed the benefits. OBJECTIVES: To examine glycemic control levels among older adults with diabetes mellitus by health status and to estimate the prevalence of potential overtreatment of diabetes. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of the data on 1288 older adults (≥65 years) with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2010 who had a hemoglobin A1c (HbA1c) measurement. All analyses incorporated complex survey design to produce nationally representative estimates. EXPOSURES: Health status categories: very complex/poor, based on difficulty with 2 or more activities of daily living or dialysis dependence; complex/intermediate, based on difficulty with 2 or more instrumental activities of daily living or presence of 3 or more chronic conditions; and relatively healthy if none of these were present. MAIN OUTCOMES AND MEASURES: Tight glycemic control (HbA1c level, <7%) and use of diabetes medications likely to result in hypoglycemia (insulin or sulfonylureas). RESULTS: Of 1288 older adults with diabetes, 50.7% (95% CI, 46.6%-54.8%), representing 3.1 million (95% CI, 2.7-3.5), were relatively healthy, 28.1% (95% CI, 24.8%-31.5%), representing 1.7 million (95% CI, 1.4-2.0), had complex/intermediate health, and 21.2% (95% CI, 18.3%-24.4%), representing 1.3 million (95% CI, 1.1-1.5), had very complex/poor health. Overall, 61.5% (95% CI, 57.5%-65.3%), representing 3.8 million (95% CI, 3.4-4.2), had an HbA1c level of less than 7%; this proportion did not differ across health status categories (62.8% [95% CI, 56.9%-68.3%]) were relatively healthy, 63.0% (95% CI, 57.0%-68.6%) had complex/intermediate health, and 56.4% (95% CI, 49.7%-62.9%) had very complex/poor health (P = .26). Of the older adults with an HbA1c level of less than 7%, 54.9% (95% CI, 50.4%-59.3%) were treated with either insulin or sulfonylureas; this proportion was similar across health status categories (50.8% [95% CI, 45.1%-56.5%] were relatively healthy, 58.7% [95% CI, 49.4%-67.5%] had complex/intermediate health, and 60.0% [95% CI, 51.4%-68.1%] had very complex/poor health; P = .14). During the 10 study years, there were no significant changes in the proportion of older adults with an HbA1c level of less than 7% (P = .34), the proportion with an HbA1c level of less than 7% who had complex/intermediate or very complex/poor health (P = .27), or the proportion with an HbA1c level of less than 7% who were treated with insulin or sulfonylureas despite having complex/intermediate or very complex/poor health (P = .65). CONCLUSIONS AND RELEVANCE: Although the harms of intensive treatment likely exceed the benefits for older patients with complex/intermediate or very complex/poor health status, most of these adults reached tight glycemic targets between 2001 and 2010. Most of them were treated with insulin or sulfonylureas, which may lead to severe hypoglycemia. Our findings suggest that a substantial proportion of older adults with diabetes were potentially overtreated.
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TL;DR
In a nationally representative NHANES sample of older US adults with diabetes from 2001–2010, most had tight glycemic control (HbA1c <7%), including many with complex/intermediate or very complex/poor health. Many of these adults were treated with insulin or sulfonylureas, suggesting substantial potential overtreatment.
Key findings
- Among 1288 older adults with diabetes, 61.5% (95% CI, 57.5%–65.3%), representing 3.8 million US adults, had HbA1c <7%; this proportion did not differ significantly by health status: 62.8% relatively healthy, 63.0% complex/intermediate, and 56.4% very complex/poor (P = .26).
- Of those with HbA1c <7%, 54.9% (95% CI, 50.4%–59.3%) were treated with insulin or sulfonylureas; treatment was similar across health status categories: 50.8% relatively healthy, 58.7% complex/intermediate, and 60.0% very complex/poor (P = .14).
- Among adults with complex/intermediate or very complex/poor health, approximately 60% (or 1.0 million) with HbA1c <7% were treated with insulin or sulfonylureas.
- Over the 10 study years, there were no significant trends in the proportion with HbA1c <7% (P = .34), the proportion with HbA1c <7% who had complex/intermediate or very complex/poor health (P = .27), or treatment with insulin/sulfonylureas among those with complex/intermediate or very complex/poor health (P = .65).
Methods
- Cross-sectional analysis of NHANES data from 2001–2010, including 1288 adults aged ≥65 years with self-reported diabetes and an HbA1c measurement; analyses incorporated complex survey design to produce nationally representative estimates.
- Health status was classified using the ADA/AGS framework: very complex/poor health if dialysis-dependent or ≥2 ADL impairments; complex/intermediate health if ≥3 chronic conditions or ≥2 IADL impairments; relatively healthy if neither.
- Outcomes were tight glycemic control (HbA1c <7%; also examined <6.5%) and use of diabetes medications likely to cause hypoglycemia (insulin or sulfonylureas); weighted proportions and logistic regression were used to assess trends.
Limitations
- The paper states that combining NHANES cycles may have underpowered detection of subtle trends; medication use relied on prescriptions brought to examination, with some combination therapies not subcategorized; health status used limited ADL/IADL questions and did not account for dementia or cognitive impairment, possibly overestimating relatively healthy adults and underestimating overtreatment; NHANES excludes institutionalized adults; direct harm such as hypoglycemia could not be determined; HbA1c is a poor predictor of self-reported serious hypoglycemia; and a possible shift in HbA1c distribution toward higher values may underestimate overtreatment.
- Evident from the text: the cross-sectional design cannot establish causality between treatment and outcomes, and the study lacked data on active cancer, clinical depression, falls, and other ADL/IADL impairments used in the ADA/AGS framework.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A total of 41.9% (95% CI, 37.9%–46.1%) of older adults had an HbA1c level of less than 6.5%”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Results
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In the paper
“Similarly, large proportions of participants with HbA1c levels of less than 6.5% were treated with insulin or sulfonylureas across health status categories (43.9% [95% CI, 36.8%–51.3%] of relatively healthy, 52.3% [95% CI, 40.4%–64.0%] with complex/intermediate health, and 56.3% [95% CI, 44.1%–67.8%] with very complex/poor health).”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Results
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In the paper
“32.2% (95% CI, 28.7%–35.9%) had an HbA1c level of 7% to 8.9%”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Results
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In the paper
“Most of them were treated with insulin or sulfonylureas, which may lead to severe hypoglycemia.”
- Also stated in: § Discussion · plain
“Moreover, approximately 60% (or 1.0 million) of adults with complex or very complex medical problems were treated with insulin or sulfonylureas to achieve tight glycemic targets, which may lead to severe hypoglycemia.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > CONCLUSIONS AND RELEVANCE
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“28.1% (95% CI, 24.8%–31.5%), representing 1.7 million (95% CI, 1.4–2.0), had complex/intermediate health”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > RESULTS
Strength:plain· not yet calibratedn = 1,288Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although the harms of intensive treatment likely exceed the benefits for older patients with complex/intermediate or very complex/poor health status, most of these adults reached tight glycemic targets between 2001 and 2010.”
- Also stated in: § Discussion · plain
“Despite unproven benefits and potential harms of tight glycemic control in older persons with extensive comorbidities, most older adults with complex/intermediate and very complex/poor health had an HbA1c level of less than 7%, corresponding to 1.8 million persons.”
- Also stated in: § Conclusions · plain
“Using a nationally representative sample of US adults, we showed that nearly two-thirds of older adults with diabetes who have complex/intermediate or very complex/poor health attained tight glycemic control.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > CONCLUSIONS AND RELEVANCE
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“this proportion did not differ across health status categories (62.8% [95% CI, 56.9%–68.3%]) were relatively healthy, 63.0% (95% CI, 57.0%–68.6%) had complex/intermediate health, and 56.4% (95% CI, 49.7%–62.9%) had very complex/poor health (P = .26).”
- Also stated in: § Results · plain
“There were no significant differences in the proportions of patients who attained tight (HbA1c level, <7%), moderate (HbA1c level, 7%–8.9%), or poor (HbA1c level, ≥9%) glycemic control across health status categories (P = .43)”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > RESULTS
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In the paper
“However, among participants with an HbA1c level of less than 7% who had complex/intermediate or very complex/poor health, treatment with insulin or sulfonylureas remained stable over time (P = .65)”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Results
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In the paper
“or the proportion with an HbA1c level of less than 7% who were treated with insulin or sulfonylureas despite having complex/intermediate or very complex/poor health (P = .65).”
- Also stated in: § Discussion · plain
“We did not find significant changes in treatment patterns across health status over time.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > RESULTS
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the older adults with an HbA1c level of less than 7%, 54.9% (95% CI, 50.4%–59.3%) were treated with either insulin or sulfonylureas”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > RESULTS
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- Probably not a substantial claim. 18
- It may state two separate claims as one. 14
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“21.2% (95% CI, 18.3%–24.4%), representing 1.3 million (95% CI, 1.1–1.5), had very complex/poor health.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > RESULTS
Strength:plain· not yet calibratedn = 1,288Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“Current recommendations for diabetes management,2,11,12 including The 2012 ADA and American Geriatrics Society (AGS) consensus statement,13 endorse higher glycemic targets for older patients with multiple comorbidities, functional impairments, established diabetic complications, or limited life expectancy.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > CONCLUSIONS AND RELEVANCE
What the sources say
- Not checked yetcites [2] American Diabetes Association Standards of medical care in diabetes: 2014 Diabetes Care 2014 37 suppl 1 S14 S80 24357209
- Not checked yetcites [11] Management of Diabetes Mellitus Update Working Group VA/DoD clinical practice guideline: management of diabetes mellitus (2010). Version 4.0 Washington, DC Veterans Health Administration and Department of Defense 2010 http://www.healthquality.va.gov/guidelines/CD/diabetes/DM2010_SUM-v4.pdf Accessed November 26, 2014
- Not checked yetcites [12] Brown AF Mangione CM Saliba D Sarkisian CA California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes Guidelines for improving the care of the older person with diabetes mellitus J Am Geriatr Soc 2003 51 5 suppl guidelines S265 S280 12694461
- Not checked yetcites [13] Kirkman MS Briscoe VJ Clark N Diabetes in older adults Diabetes Care 2012 35 12 2650 2664 23100048 PMC3507610
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In the paper
“Glucose-lowering agents have been implicated in one-fourth of emergency hospitalizations for adverse drug events in older US adults, nearly all of them for hypoglycemia.9”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > CONCLUSIONS AND RELEVANCE
What the sources say
- Not checked yetcites [9] Budnitz DS Lovegrove MC Shehab N Richards CL Emergency hospitalizations for adverse drug events in older Americans N Engl J Med 2011 365 21 2002 2012 22111719
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In the paper
“We could not determine the presence of other indicators of very complex/poor health status per the ADA/AGS framework, including end-stage (stage III–IV) congestive heart failure, oxygen-dependent lung disease, uncontrolled metastatic cancer, or severe cognitive impairment.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Health Status
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In the paper
“All analyses incorporated complex survey design to produce nationally representative estimates.”
- Also stated in: § Statistical Analysis · plain
“All analyses incorporated a complex survey design using NHANES-recommended methods to produce nationally representative estimates.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > DESIGN, SETTING, AND PARTICIPANTS
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- Also stated in: § Statistical Analysis · plain
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In the paper
“We also did not include hypertension because it is highly prevalent and usually not considered a serious chronic illness.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Health Status
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In the paper
“We classified older adults with diabetes into 3 health status categories endorsed by the ADA/AGS framework for considering treatment goals for glycemia.13”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Health Status
What the sources say
- Not checked yetcites [13] Kirkman MS Briscoe VJ Clark N Diabetes in older adults Diabetes Care 2012 35 12 2650 2664 23100048 PMC3507610
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In the paper
“Receipt and type of oral glucose-lowering treatment was based on review of medications brought in to the examination; insulin use was based on review of medications brought in or self-reported use of insulin, because participants may not always bring vials or pens to the examination.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Glucose-Lowering Treatment
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In the paper
“To preserve statistical power in these trend analyses, we combined participants with complex/intermediate and very complex/poor health status into 1 category.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Statistical Analysis
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“we did not have information on active cancer, clinical diagnosis of depression, or falls.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Health Status
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In the paper
“The NHANES uses stratified, multistage, probability-cluster techniques to ensure that sample populations are representative of the nation’s noninstitutionalized civilians.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Study Source
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In the paper
“Laboratory method crossover studies were conducted at the time of each of the laboratory instrument changes.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Glycemic Control
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In the paper
“The reasons for higher glycemic targets in these persons are 2-fold: intensive glycemic control is unlikely to result in a benefit, but it is associated with a risk for harm.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Abstract > CONCLUSIONS AND RELEVANCE
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In the paper
“Other ADLs and instrumental ADLs were not assessed in the NHANES.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Health Status
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In the paper
“This study was deemed exempt from further review by the University of California, San Francisco, Institutional Review Board because it used only deidentified secondary data.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Study Source
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In the paper
“Both laboratories that analyzed NHANES HbA1c data from 2001–2010 were standardized by participating in the National Glycohemoglobin Standardization Program, and no adjustment across years for the HbA1c assay has been recommended.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Methods > Glycemic Control
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In the paper
“Some combinations of comorbid conditions used to categorize health status may have stronger associations with hypoglycemia and life expectancy than others; however, to the extent possible, we have followed the ADA/AGS framework,13 which does not distinguish between these combinations.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Discussion
What the sources say
- Not checked yetcites [13] Kirkman MS Briscoe VJ Clark N Diabetes in older adults Diabetes Care 2012 35 12 2650 2664 23100048 PMC3507610
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In the paper
“In addition, we incorporated functional impairments, which are an important risk factor for adverse outcomes in diabetes treatment but are not captured in administrative records such as those used in the study by Tseng et al.19”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Discussion
What the sources say
- Not checked yetcites [19] Tseng CL Soroka O Maney M Aron DC Pogach LM Assessing potential glycemic overtreatment in persons at hypoglycemic risk JAMA Intern Med 2014 174 2 259 268 24322626
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The ADA has only recently endorsed individualized glycemic targets, and it is possible that potential overtreatment may have declined since 2010; however, the Veteran Affairs and AGS guidelines have endorsed this approach for nearly a decade and we detected no signal to suggest a change.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Discussion
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In the paper
“We were not able to determine whether potential overtreatment directly resulted in harm, such as hypoglycemia.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Discussion
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In the paper
“We combined NHANES data from 2001 through 2010 to increase our sample size, but our study may have been underpowered to detect more subtle changes in treatment patterns over time.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Discussion
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These vulnerable adults are unlikely to experience the benefits of intensive glycemic control and instead are likely to experience harms from treatment, such as hypoglycemia and other adverse effects.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Conclusions
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In the paper
“We used nationally representative samples (with equal numbers of men and women) served by different health systems that are more generalizable to the US population at large.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Discussion
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Given incomplete information on all comorbidities in our study, it is likely that we underestimated the complexity of health status, and thus, true estimates of adults who are potentially overtreated may be even higher.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We categorized participants according to health status based on a limited number of questions about ADL and instrumental ADL impairments and did not take into account dementia or cognitive impairment; therefore, we may have overestimated the number of adults who were relatively healthy and underestimated potential overtreatment.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Discussion
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In the paper
“Use of medications was based on prescriptions brought in for examination; a small percentage of medications were classified in NHANES as combination therapy and were not otherwise subcategorized, although some may have included sulfonylureas.”
§ Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control > Discussion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Claims other papers make about this one
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The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Therefore, it has been suggested that a tight glycemic control with a target A1C of 6.0% may not be ideal for older/frail individuals, those with longer duration of diabetes, advanced coronary artery disease (CAD) and a known history of severe hypoglycemia (32,33)”
From Targets for Glycemic Control (2018) · cites this paper as [33]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Intensive glycemic management with medication plans including insulin and sulfonylureas in older adults with complex medical conditions has been identified as overtreatment and found to be very common in clinical practice (100-104)”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [102]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Intensive glycemic management in older adults, particularly those with complex health status, with medication plans that increase the risk of hypoglycemia through use of insulin and/or sulfonylureas has been identified as overtreatment, is common in clinical practice”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [111]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Intensive glycemic management with medication plans including insulin and sulfonylureas in older adults with complex medical conditions has been identified as overtreatment and found to be very common in clinical practice (100-104)”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [102]
In the citing paper
“Individuals with a long duration of diabetes, a known history of hypoglycemia, advanced atherosclerosis, or advanced age/frailty may benefit from less aggressive targets (67,68).”
From 6. Glycemic Targets: Standards of Care in Diabetes—2023 (2023) · cites this paper as [67]
Citations
Cites
Standards of Medical Care in Diabetes
Power, D. V. (2006) · Diabetes Care · doi:10.2337/diacare.29.02.06.dc05-1593 · Cited by 8,675
Effects of Intensive Glucose Lowering in Type 2 Diabetes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0802743 · Cited by 7,888
Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0802987 · Cited by 7,397
Glucose control and vascular complications in veterans with type 2 diabetes
Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P. D., Zieve, F. J., Marks, J., Davis, S. N., Hayward, R., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0808431 · Cited by 4,762
Standards of medical care in diabetes—2014
American Diabetes Association (2014) · Diabetes Care · doi:10.2337/dc14-s014 · Cited by 4,572
Emergency hospitalizations for adverse drug events in older Americans.
Budnitz, D., Lovegrove, M., Shehab, N., & Richards, C. (2011) · New England Journal of Medicine · doi:10.1056/nejmsa1103053 · Cited by 1,748
Seaquist, E. R., Anderson, J., Childs, B., Cryer, P., Dagogo-Jack, S., Fish, L., Heller, S. R., Rodriguez, H., Rosenzweig, J., & Vigersky, R. (2013) · Diabetes Care · doi:10.2337/dc12-2480 · Cited by 1,389
Kirkman, M. S., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Huang, E. S., Korytkowski, M. T., Munshi, M. N., Odegard, P. S., et al. (2012) · Diabetes Care · doi:10.2337/dc12-1801 · Cited by 1,274
Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus
Whitmer, R. A. (2009) · JAMA · doi:10.1001/jama.2009.460 · Cited by 1,128
Gerstein, H. C., Miller, M., & Byington, R. P. (2010) · Cited by 981
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Items 101–200 of 408
Zaccardi, F., Dhalwani, N. N., Webb, D. R., Davies, M. J., & Khunti, K. (2018) · Diabetologia · doi:10.1007/s00125-018-4626-y · Cited by 41
“An unnecessary intensive use of glucoselowering therapies for older individuals with diabetes and multimorbidity has been reported in the USA and could explain our results [33, 34].”
ResultLega, I. C., Campitelli, M. A., Austin, P. C., Na, Y., Zahedi, A., Leung, F., Yu, C., Bronskill, S. E., Rochon, P. A., & Lipscombe, L. L. (2021) · Diabetologia · doi:10.1007/s00125-020-05370-7 · Cited by 40
“ties, despite these groups being at the highest risk of hypoglycaemia and least likely to benefit from intensive glycaemic targets [8, 42].”
BackgroundEchouffo-Tcheugui, J. B., Daya, N. R., Lee, A. K., Tang, O., Ndumele, C. E., Windham, B. G., Shah, A. M., & Selvin, E. (2020) · Diabetes Care · doi:10.2337/dc20-0552 · Cited by 37
Mata‐Cases, M., Franch‐Nadal, J., Real, J., Vlacho, B., Gómez‐García, A., & Mauricio, D. (2021) · Primary care diabetes · doi:10.1016/j.pcd.2021.02.003 · Cited by 40
Appropriate Prescribing for Patients With Diabetes at High Risk for Hypoglycemia
Caverly, T. J., Fagerlin, A., Zikmund‐Fisher, B. J., Kirsh, S. R., Kullgren, J. T., Prenovost, K. M., & Kerr, E. A. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.5950 · Cited by 39
Fujiwara, T., Takamoto, I., Amemiya, A., Hanazato, M., Suzuki, N., Nagamine, Y., Sasaki, Y., Tani, Y., Yazawa, A., Inoue, Y., et al. (2017) · Social Science & Medicine · doi:10.1016/j.socscimed.2017.04.008 · Cited by 41
Tratamiento de la diabetes mellitus tipo 2 en el paciente anciano
Gómez‐Huelgas, R., Peralta, F. G., Rodríguez‐Mañas, L., Formiga, F., Puig‐Domingo, M., Bravo, J. J. M., Miranda, C., & Ena, J. (2018) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2017.12.003 · Cited by 42
Luo, J., Khan, N. F., Manetti, T., Rose, J., Kaloghlian, A., Gadhe, B., JAIN, S. H., Gagne, J. J., & Kesselheim, A. S. (2019) · JAMA · doi:10.1001/jama.2018.21364 · Cited by 39
Munshi, M. N., Kahkoska, A. R., Neumiller, J. J., Alexopoulos, A., Allen, N. A., Cukierman‐Yaffe, T., Huang, E. S., Lee, S. J., Lipska, K. J., McCarthy, L. M., et al. (2025) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(24)00372-3 · Cited by 42
Self-citationProtecting Skeletal Muscle with Protein and Amino Acid during Periods of Disuse
Galvan, E., Arentson‐Lantz, E. J., Lamon, S., & Paddon‐Jones, D. (2016) · Nutrients · doi:10.3390/nu8070404 · Cited by 38
Hambling, C. E., Khunti, K., Cos, X., Wens, J., Martinez, L., Topsever, P., Prato, S. D., Sinclair, A. J., Schernthaner, G., Rutten, G. E. H. M., et al. (2019) · Primary care diabetes · doi:10.1016/j.pcd.2018.12.005 · Cited by 38
Frailty and Diabetes in Older Hospitalized Adults: The Case for Routine Frailty Assessment
MacKenzie, H., Tugwell, B. D., Rockwood, K. J., & Theou, O. (2019) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2019.07.001 · Cited by 38
Christiaens, A., Henrard, S., Zerah, L., Dalleur, O., Bourdel‐Marchasson, I., & Boland, B. B. (2021) · Age and Ageing · doi:10.1093/ageing/afab157 · Cited by 39
Sönmez, A., Haymana, C., Bayram, F., Salman, S., Dizdar, O. S., Gürkan, E., Çarlıoğlu, A., Barçın, C., Sabuncu, T., Satman, İ., et al. (2018) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2018.09.010 · Cited by 37
Hamada, S., & Gulliford, M. C. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14215 · Cited by 34
“A recent study in the United States suggested possible overtreatment with antidiabetic drugs in older adults with diabetes mellitus, especially those treated with insulin or sulphonylureas, which may cause severe hypoglycemia.(29) A meta-analysis of randomized controlled trials indicated that antihypertensive medicati…”
BackgroundAging, the Medical Subspecialties, and Career Development: Where We Were, Where We Are Going
Hurria, A., High, K. P., Mody, L., Horne, F. M., Escobedo, M. R., Halter, J. B., Hazzard, W. R., Schmader, K. E., Klepin, H. D., Lee, S., et al. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14708 · Cited by 34
“Among the most recent scholars, one is now an NIA Paul Beeson Career Development awardee who has established the prognostic value of frailty in liver transplantation,(14) and another has recently published a paper on the overtreatment of diabetes mellitus in older adults with tight glycemic control.(15) This is the la…”
BackgroundSelf-citationClinical inertia versus overtreatment in glycaemic management
Khunti, K. K., & Davies, M. J. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30339-x · Cited by 34
Prevalence and Risk of Polypharmacy among Community-Dwelling, Elderly Kuwaiti Patients
Badawy, N. A., Labeeb, S. A., Alsamdan, M. F., & Alazemi, B. F. (2019) · Medical Principles and Practice · doi:10.1159/000503298 · Cited by 33
Zaccardi, F., Ling, S., Lawson, C. A., Davies, M. J., & Khunti, K. (2020) · Diabetologia · doi:10.1007/s00125-020-05223-3 · Cited by 33
Ling, S., Zaccardi, F., Lawson, C., Seidu, S., Davies, M. J., & Khunti, K. (2021) · Diabetes Care · doi:10.2337/dc20-0876 · Cited by 39
Huang, R., Yan, L., & Lei, Y. (2021) · BMC Endocrine Disorders · doi:10.1186/s12902-021-00863-x · Cited by 31
“However, HbA1C depicts a 2-3-month average plasma glucose concentration and may not capture daily blood glucose swings or variability during patients’ daily lives [1, 8, 9].”
BackgroundKotsani, M., Chatziadamidou, T., Economides, D., & Bénétos, A. (2017) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2017.10.026 · Cited by 31
Hart, H. E., Ditzel, K., Rutten, G. E. H. M., GROOT, E. D., Seidu, S., Khunti, K., & Vos, R. C. (2019) · Patient Preference and Adherence · doi:10.2147/ppa.s208947 · Cited by 31
Antihypertensive Drug Deintensification and Recurrent Falls in Long‐Term Care
Song, W., Intrator, O. K., Lee, S., & Boockvar, K. S. (2018) · Health Services Research · doi:10.1111/1475-6773.13074 · Cited by 30
“This is consistent with a study that showed that diabetes treatment intensity was not tailored to functional status in older adults, despite the harms of intensive treatment likely exceeding the benefits in those with significant disability (Lipska et al. 2015).”
BackgroundResultSelf-citationPatient Perceptions of Diabetes Guideline Frameworks for Individualizing Glycemic Targets
Schoenborn, N. L., Crossnohere, N. L., Bridges, J. F. P., Pollack, C. E., Pilla, S. J., & Boyd, C. M. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.3806 · Cited by 30
Hypoglycaemia in older home-dwelling people with diabetes- a scoping review
Hermann, M., Heimro, L. S., Haugstvedt, A., Hernar, I., Sigurðardóttir, Á. K., & Graue, M. (2021) · BMC Geriatrics · doi:10.1186/s12877-020-01961-6 · Cited by 29
“showed that older individuals are subjected to a tighter glycaemic control than recommended [33, 40, 41, 49].”
BackgroundInfluentialA Qualitative Study of Perspectives of Older Adults on Deintensifying Diabetes Medications
Pilla, S. J., Meza, K., Schoenborn, N. L., Boyd, C. M., Maruthur, N. M., & Chander, G. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-022-07828-3 · Cited by 34
“0%, the lowest target in guidelines.(7,8) Guidelines recommend individualizing glycemic targets for older adults with higher targets for those with multiple chronic conditions, impairments in physical and cognitive function, or limited life expectancy.”
BackgroundWhat works for whom in the management of diabetes in people living with dementia: a realist review
Bunn, F., Goodman, C., Reece Jones, P., Russell, B., Trivedi, D., Sinclair, A., Bayer, A., Rait, G., Rycroft-Malone, J., & Burton, C. (2017) · BMC Medicine · doi:10.1186/s12916-017-0909-2 · Cited by 28
“Despite this, there is evidence that a substantial proportion of older adults are potentially overtreated [128].”
Koto, R., Nakajima, A., Miwa, T., & Sugimoto, K. (2023) · Diabetes Therapy · doi:10.1007/s13300-023-01421-5 · Cited by 30
“However, previous studies have revealed overtreatment in older patients or in patients with serious comorbidities [18, 19], and young adult patients have shown poorer glycemic control than older patients [20, 21].”
BackgroundMcAlister, F. A., Lethebe, B. C., Lambe, C., Williamson, T. S., & Lowerison, M. W. (2018) · Cardiovascular Diabetology · doi:10.1186/s12933-018-0673-4 · Cited by 29
Outcomes of Hospitalized Patients with Glucocorticoid-Induced Hyperglycemia—A Retrospective Analysis
Delfs, N., Struja, T., Gafner, S., Muri, T., Baechli, C., Schüetz, P., Müeller, B., & Blum, C. A. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9124079 · Cited by 33
Pascali, C. D., Francioso, L. N., Giampetruzzi, L., Rescio, G., Signore, M. A., Leone, A., & Siciliano, P. A. (2021) · Sensors · doi:10.3390/s21051847 · Cited by 31
“This is caused by an insulin overtreatment or also a negligence generated by the fear of injection-related pain for repetitive blood collection and insulin shots [49,50].”
BackgroundAlexopoulos, A., Kahkoska, A. R., Pate, V., Bradley, M. C., Niznik, J. D., Thorpe, C. T., Stürmer, T., & Buse, J. B. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.32215 · Cited by 28
Trends in Diabetes Treatment and Monitoring among Medicare Beneficiaries
Landon, B. E., Zaslavsky, A. M., Souza, J., & Ayanian, J. Z. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4310-4 · Cited by 28
Chokshi, S. K., Belli, H. M., Troxel, A. B., Blecker, S., Blaum, C. S., Testa, P. A., & Mann, D. (2019) · Pilot and Feasibility Studies · doi:10.1186/s40814-019-0403-z · Cited by 26
“Despite the CW recommendations, a substantial number of older adults have intensive glycemic control that may not be necessary [22 – 24].”
BackgroundBruce, D. G., Davis, W. A., & Davis, T. M. E. (2018) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13469 · Cited by 25
“It has been estimated that between 20% and 60% of older patients with diabetes in the USA may be overtreated.(11,17,18) Treatment with insulin and sulphonylureas, commonly used in contemporary practice,(19) may be particularly hazardous in this situation, whereas metformin is recommended for firstline treatment becaus…”
BackgroundGlycemic treatment deintensification practices in nursing home residents with type 2 diabetes
Lederle, L. I., Steinman, M. A., Jing, B., Nguyen, B., & Lee, S. J. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17735 · Cited by 24
Self-citationLe, P., Ayers, G., Misra-Hebert, A. D., Herzig, S. J., Herman, W. H., Shaker, V. A., & Rothberg, M. B. (2022) · Diabetes Care · doi:10.2337/dc21-1507 · Cited by 26
Approaches to risk assessment among older patients with diabetes
Pilla, S. J., Schoenborn, N. L., Maruthur, N. M., & Huang, E. S. (2019) · Current Diabetes Reports · doi:10.1007/s11892-019-1172-z · Cited by 24
Does true Gleason pattern 3 merit its cancer descriptor?
Miah, S., Ahmed, H. U., Freeman, A., & Emberton, M. (2016) · Nature Reviews Urology · doi:10.1038/nrurol.2016.141 · Cited by 23
Doucet, J., Gourdy, P., Meyer, L., Benabdelmoumene, N., & Bourdel‐Marchasson, I. (2023) · Clinical Interventions in Aging · doi:10.2147/cia.s423122 · Cited by 22
“0% (53 mmol/mol) while being treated with hypoglycemia-associated drugs (insulin and/or sulfonylureas), regardless of their functional status.(23) Having a safe lower limit for HbA1c level may thus be helpful in patients treated with insulin and insulin secretagogues.”
MethodGeijteman, E. C. T., Huisman, B. A. A., Dees, M., Perez, R. S. G. M., van der Rijt, C. C. D., van Zuylen, L., & van der Heide, A. (2018) · Journal of Palliative Medicine · doi:10.1089/jpm.2017.0501 · Cited by 22
Rooney, M. R., Tang, O., Echouffo-Tcheugui, J. B., Lutsey, P. L., Grams, M. E., Windham, B. G., & Selvin, E. (2021) · Diabetes Care · doi:10.2337/dc20-3045 · Cited by 24
Zaccardi, F., Davies, M. J., & Khunti, K. (2020) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13929 · Cited by 22
“older, frail patients with multimorbidity may result in a higher risk of hypoglycaemia, which has been associated with short and long-term complications: primary care, administrative, claim, and survey data have demonstrated an increased risk of hypoglycaemia in older patients with multimorbidity,(24-26) higher cardio…”
BackgroundSevere Hypoglycemia Attributable to Intensive Glucose-Lowering Therapy Among US Adults With Diabetes
Mahoney, G. K., Henk, H. J., & McCoy, R. G. (2019) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2019.02.028 · Cited by 21
Abdelhafiz, A. H., Peters, S., & Sinclair, A. J. (2021) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2021.109085 · Cited by 22
Boulin, M., Diaby, V., & Tannenbaum, C. (2016) · PLoS ONE · doi:10.1371/journal.pone.0162951 · Cited by 21
Avramidis, I., Apsemidou, A., Lalia, A. Z., Petridis, N., Tourtouras, E., Kalopitas, G., & Pilianidis, G. (2019) · Clinical Diabetes · doi:10.2337/cd19-0090 · Cited by 22
Langerman, C., Forbes, A., & Robert, G. (2022) · Primary care diabetes · doi:10.1016/j.pcd.2022.08.008 · Cited by 22
Christiaens, A., Baretella, O., Giovane, C. D., Rodondi, N., Knol, W., Peters, M. J. L., Jennings, E., O’Mahony, D., Spinewine, A., Boland, B. B., et al. (2023) · Age and Ageing · doi:10.1093/ageing/afac320 · Cited by 21
“However, there are limited data on the association between clinical outcomes and overtreatment of diabetes in older patients particularly in populations usually less represented in studies, such as multimorbid older people [17, 18].”
BackgroundInteractive Web-Based Learning
Rider, B. B., Lier, S. C., Johnson, T., & Hu, D. J. (2015) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.07.038 · Cited by 20
Huang, E. S., Nathan, A. G., Cooper, J. M., Lee, S. M., Shin, N. Y., John, P. M., Dale, W., Col, N. F., Meltzer, D. O., & Chin, M. H. (2016) · Medical Decision Making · doi:10.1177/0272989x16654142 · Cited by 20
Self-citationAssociation of hemoglobin A1c time in range with risk for diabetes complications
Mohr, D. C., Zhang, L., Prentice, J. C., Nelson, R. E., Li, D., Pleasants, E. A., & Conlin, P. R. (2022) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2021-002738 · Cited by 22
Deintensification of Routine Medical Services
Kerr, E. A., & Hofer, T. P. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.2292 · Cited by 19
Sönmez, A., Taşçı, İ., Demirci, İ., Haymana, C., Barçın, C., Aydin, H., Çetinkalp, Ş., Öztürk, F. Y., Gül, K., Sabuncu, T., et al. (2020) · Diabetes Therapy · doi:10.1007/s13300-020-00779-0 · Cited by 18
Glycemic Control in Older Adults With Diabetes Mellitus
Huang, E. S., & Davis, A. M. (2015) · JAMA · doi:10.1001/jama.2015.8345 · Cited by 18
Meneilly, G. S., Berard, L., CHENG, A. Y. Y., Lin, P., MacCallum, L., Tsuyuki, R. T., Yale, J., Nasseri, N., Richard, J.-F., Goldin, L., et al. (2017) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2017.03.003 · Cited by 20
Lysy, Z., Fung, K., Giannakeas, V., Fischer, H. D., Bell, C. M., & Lipscombe, L. L. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-04849-3 · Cited by 19
Evaluating glucose‐lowering treatment in older people with diabetes: Lessons from the IMPERIUM trial
Sinclair, A. J., Heller, S. R., Pratley, R. E., Duan, R., Heine, R. J., Festa, A., & Kiljanski, J. I. (2020) · Diabetes Obesity and Metabolism · doi:10.1111/dom.14013 · Cited by 19
Type 2 diabetes management in people aged over seventy-five years: targets and treatment strategies
Koufakis, T., Grammatiki, M., & Kotsa, K. (2020) · Maturitas · doi:10.1016/j.maturitas.2020.10.005 · Cited by 18
Simplification of complex insulin therapy: a story of dogma and therapeutic resignation
Giugliano, D., Scappaticcio, L., Longo, M., Caruso, P., Maiorino, M. I., Bellastella, G., & Esposito, K. (2021) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2021.108958 · Cited by 18
POGACH, L. M., Tseng, C., Soroka, O., Maney, M., & Aron, D. C. (2016) · Diabetes Care · doi:10.2337/dc16-0953 · Cited by 17
Christiaens, A., Henrard, S., Boland, B. B., & Sinclair, A. J. (2022) · Diabetic Medicine · doi:10.1111/dme.14994 · Cited by 17
Managing diabetes in people with dementia: a realist review
Bunn, F., Goodman, C. M., Jones, P. R., Russell, B., Trivedi, D. P., Sinclair, A. J., Bayer, A. J., Rait, G., Rycroft‐Malone, J., & Burton, C. R. (2017) · Health Technology Assessment · doi:10.3310/hta21750 · Cited by 20
The Phenotype of Elderly Patients with Type 2 Diabetes Mellitus and Poor Sleep Quality
Mikołajczyk-Solińska, M., Śliwińska, A., Kosmalski, M., & Drzewoski, J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17165992 · Cited by 18
“Tight glycemic control and use of diabetes medications, especially insulin and sulphonylureas, could result in hypoglycemia [47].”
BackgroundAssessment of glycemic control in nursing home residents with diabetes
Rétornaz, F., Grino, M., Mari, L., & Oliver, C. (2016) · The journal of nutrition health & aging · doi:10.1007/s12603-016-0776-0 · Cited by 17
“Indeed in older adults with cognitive impairment, the prevalence of hypoglycemia may be underestimated due to the unawareness of warning symptoms (5, 27, 30).”
Wojszel, Z. B., & Kasiukiewicz, A. (2019) · BMC Geriatrics · doi:10.1186/s12877-019-1256-2 · Cited by 18
“results of studies carried out in the USA and covering patients with type 2 diabetes in the age of 65 years or older with comorbid dementia, which covered the years 2008–2009, which found that one half had HbA1C < 7% [53 mmol/mol] despite clear guidelines recommending higher glycemic targets, and the majority of the u…”
ResultChristiaens, A., Boland, B. B., Germanidis, M., Dalleur, O., & Henrard, S. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01780-9 · Cited by 17
Gómez‐Huelgas, R., Peralta, F. G., & Cos, X. (2022) · Revista Clínica Española (English Edition) · doi:10.1016/j.rceng.2021.11.007 · Cited by 16
Herledan, C., Toulemonde, A., Clairet, A., Boulin, M., Falandry, C., de Decker, L., Rioufol, C., Bayle, A., & Bertrand, N. (2023) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2023.104117 · Cited by 16
Using Behavioral Economics to Reduce Low-Value Care Among Older Adults
Kullgren, J. T., Kim, H. M., Slowey, M., Colbert, J., Soyster, B. C., Winston, S. A., Ryan, K. A., Forman, J. H., Riba, M. L., Krupka, E. L., et al. (2024) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2023.7703 · Cited by 17
Standards of Care in Diabetes. The position of Diabetes Poland – 2024
Araszkiewicz, A., Bandurska-Stankiewicz, E. M., Borys, S., Broncel, M., Budzynski, A. Z., Cyganek, K., Cypryk, K., CYRANKA, K. M., Czupryniak, L., Dzida, G. J., et al. (2024) · Current Topics in Diabetes · doi:10.5114/ctd/183052 · Cited by 17
Formiga, F., Franch‐Nadal, J., Rodriguez, L., Ávila, L., & Fuster, E. (2017) · The journal of nutrition health & aging · doi:10.1007/s12603-017-0869-4 · Cited by 16
“(8, 18).”
Potential Overtreatment of Older, Complex Adults With Diabetes
Huang, E. S. (2015) · JAMA · doi:10.1001/jama.2015.9757 · Cited by 16
Is glycemia control in Canadians with diabetes individualized? A cross-sectional observational study
Coons, M. J., Greiver, M., Aliarzadeh, B., Meaney, C. A., Moineddin, R., Williamson, T. S., Queenan, J. A., Yu, C. H. Y., White, D. G., Kiran, T., et al. (2017) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2016-000316 · Cited by 17
“Some studies have shown that older persons may be more likely to have HbA1c values ≤7% (53 mmol/ mol) than younger persons(13) 14 indicating possible overtreatment in some elders.(15) Overtreatment in elders was defined as the use of glucose-lowering medications (other than metformin) associated with an increased risk…”
BackgroundMellot, M., Jawal, L., Morel, T., Fournier, J., Tubach, F., Cadwallader, J., Christiaens, A., & Zerah, L. (2024) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2023.11.025 · Cited by 15
McAlister, F. A., Youngson, E. R. E., & Eurich, D. T. (2016) · Medicine · doi:10.1097/md.0000000000003894 · Cited by 16
Bongaerts, B. W. C., Arnold, S. V., Charbonnel, B. H., Chen, H., Cooper, A., Fenici, P., Gomes, M. B., Ji, L., Khunti, K. K., Kosiborod, M., et al. (2021) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2020-001585 · Cited by 15
De-Intensification of Diabetes Treatment in Elderly Patients with Type 2 Diabetes Mellitus
Pírela, D., & Garg, R. (2019) · Endocrine Practice · doi:10.4158/ep-2019-0303 · Cited by 15
Abdelhafiz, A. H., Keegan, G. L., & Sinclair, A. J. (2023) · Metabolites · doi:10.3390/metabo13060705 · Cited by 16
“, in their cross-sectional study, demonstrated that frail patients with complex health status are significantly older, have higher BMI, more comorbidities, and disabilities but similar HbA1c levels compared to more healthy patients [37].”
BackgroundInfluentialLega, I. C., Campitelli, M. A., Matlow, J. N., Na, Y., Stall, N. M., Rochon, P. A., & Lipscombe, L. L. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2021.0022 · Cited by 14
Therapeutic Inertia is a Problem for All of Us
Brunton, S. (2019) · Clinical Diabetes · doi:10.2337/cd19-0009 · Cited by 17
Vascular risk assessment in older adults without a history of cardiovascular disease
Bambrick, P., Tan, W. S., Mulcahy, R., Pope, G., & Cooke, J. P. (2016) · Experimental Gerontology · doi:10.1016/j.exger.2016.03.002 · Cited by 15
Korytkowski, M. T., & Forman, D. E. (2017) · Diabetes Care · doi:10.2337/dc16-0815 · Cited by 14
“IP therapy was the most frequently used glucose-lowering therapy and has been observed to account for the majority of emergency department visits for hypoglycemia among adults aged $65 years (15,80).”
BackgroundGlycaemic control and treatment of type 2 diabetes in adults aged 75 years or older
Rodríguez‐Poncelas, A., Barrot, J., de Tuero, G. C., López-Arpí, C., Vlacho, B., López‐Simarro, F., Mundet, X., & Franch‐Nadal, J. (2018) · International Journal of Clinical Practice · doi:10.1111/ijcp.13075 · Cited by 14
Kloos, C., Burghardt, K., Müller, U., Kramer, G., Muller, N., Wolf, G., & Kuniß, N. (2019) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-0983-1559 · Cited by 14
“Recent studies from cohorts with elderly people with DM2 demonstrated that a considerable section of these individuals are at risk because of diabetes therapy [16, 21] and the risk of severe hypoglycaemia is clearly associated with complex insulin regimes [16].”
BackgroundThe cost of influence: How gifts to physicians shape prescriptions and drug costs
Newham, M., & Valente, M. (2024) · Journal of Health Economics · doi:10.1016/j.jhealeco.2024.102887 · Cited by 16
Intensive glycemic control in younger and older U.S. adults with type 2 diabetes
Casagrande, S. S., Cowie, C. C., & FRADKIN, J. E. (2017) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2017.05.006 · Cited by 13
“0% and significant health problems, 60% were treated with insulin or sulfonylureas; these results indicate possible overtreatment.(10) However, the practice patterns in younger adults with longer life expectancy, versus older adults, are relatively unknown.”
BackgroundResultSarkar, U., Lyles, C. R., Steinman, M. A., Huang, E. S., Moffet, H. H., Whitmer, R. A., Warton, E. M., & Karter, A. J. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14429 · Cited by 13
Self-citationSevere hypoglycemia in the Look AHEAD Trial
Greenway, F. L. (2016) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2016.03.016 · Cited by 13
“This is important, since it indicates that greater care is needed to adjust insulin during intensive weight loss (Lipska et al., 2015).”
BackgroundIs avoidance of hypoglycaemia a better target than HbA1C in older people with diabetes?
Mattishent, K., & Loke, Y. K. (2020) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.14517 · Cited by 13
“Lipska et al. have pointed out that older people may not benefit from tight glycaemic control in the same way that younger adults do and that older people are prone to serious adverse effects of hypoglycaemia from intensive therapy targeted at lowering HbA1C.2 Various guidelines for the management of diabetes in older…”
BackgroundContinuous glucose monitoring in older people with diabetes receiving home care—a feasibility study
Larsen, A. B., Hermann, M., & Graue, M. (2021) · Pilot and Feasibility Studies · doi:10.1186/s40814-020-00754-3 · Cited by 19
Karter, A. J., Parker, M. M., Moffet, H. H., Lipska, K. J., Laiteerapong, N., Grant, R. W., Lee, C., & Huang, E. S. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08219-y · Cited by 13
Self-citationRoth, J., Muller, N., Lehmann, T., Böer, K., Lobel, S. A., Pum, J. K. W., & Müller, U. (2017) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/s-0043-110053 · Cited by 12
“For a considerable group (especially elderly patients) this could lead to overtreatment [13, 14] and its associated consequences.”
Physician perspectives on de-intensifying diabetes medications
Genere, N., Sargis, R. M., Masi, C. M., Nathan, A. G., Quinn, M. T., Huang, E. S., & Laiteerapong, N. (2016) · Medicine · doi:10.1097/md.0000000000005388 · Cited by 12
“Physicians that do not individualize goals may pursue overly aggressive treatments with uncertain benefits and potential harm.([5,15,17]) We also found that physicians considered several different predefined HbA1C thresholds when deciding to initiate conversations about medication de-intensification.”
BackgroundDiabetes Deprescribing in Older Adults: A Randomized Clinical Trial
Grant, R. W., Peterson, I., McCloskey, J. M., Lipska, K. J., Nugent, J., Karter, A. J., & Gilliam, L. K. (2025) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2025.2015 · Cited by 11
Self-citationDiabetes and Frail Older Patients: Glycemic Control and Prescription Profile in Real Life
Mangé, A.-S., Pagès, A., Sourdet, S., Cestac, P., & McCambridge, C. (2021) · Pharmacy · doi:10.3390/pharmacy9030115 · Cited by 11
Brown, T., Rowe, T. A., Lee, J. Y., Petito, L. C., Chmiel, R., Ciolino, J. D., Doctor, J. N., Fox, C. R., Goldstein, N. J., Kaiser, D., et al. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106649 · Cited by 11
Impact of a pharmacist-led diabetes management on outcomes, utilization, and cost
Maeng, D. D., Graham, J., Bogart, M., Hao, J. C., & Wright, E. A. (2018) · ClinicoEconomics and Outcomes Research · doi:10.2147/ceor.s174595 · Cited by 11
“0 1 2 3 4 5 6 7+ (max 12) 896 (33) 866 (31) 489 (18) 247 (9) 136 (5) 71 (3) 25 (1) 23 (<1) 884 (32) 758 (28) 516 (19) 306 (11) 148 (5) 94 (3) 21 (1) 23 (1) 0.”
Lederle, L. I., Jing, B., Rodriguez, A. M., Hunt, L. J., & Lee, S. J. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05479-5 · Cited by 11
Self-citation
Metadata
- Authors
- Lipska, K. J., Ross, J. S., Miao, Y., Shah, N. D., Lee, S. J., & Steinman, M. A.
- Affiliations
- Yale New Haven Hospital (US)
- San Francisco VA Medical Center (US)
- Mayo Clinic (US)
- Corresponding author
- Lipska, Kasia J.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2015-03-01
- Volume
- 175
- Issue
- 3
- Pages
- 356
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC4426991
- OpenAlex
- W1985992465
- Cited by
- 408
- References
- 34
- Citations by year
- 2026: 23 · 2025: 26 · 2024: 22 · 2023: 18 · 2022: 35 · 2021: 38 · 2020: 41 · 2019: 48 · 2018: 43 · 2017: 43 · 2016: 46 · 2015: 24
- FWCI
- 45.09
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR000142)
- National Institute on Aging (K08AG032886, L30 AG045923, K23AG030999, K23AG048359, P30 AG21342, R03AG045086, T32AG019134, P30AG021342, P30AG044281)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- diabetes mellitus, older adults, overtreatment, tight glycemic control, HbA1c, hypoglycemia, insulin, sulfonylureas, comorbidities, functional limitations, activities of daily living, instrumental activities of daily living, health status, diabetes medication use, NHANES, cost-effectiveness, quality of life
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Health Status, Glycated Hemoglobin, Humans, Hypoglycemia, Iatrogenic Disease, Insulin, Male, Sulfonylurea Compounds
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