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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]
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Flagged first, then by citations
Cited by
Sorted by citations
Chatterjee, S., Khunti, K., & Davies, M. J. (2017) · The Lancet · doi:10.1016/s0140-6736(17)30058-2 · Cited by 2,577
6. Glycemic Targets: Standards of Medical Care in Diabetes—2022
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s006 · Cited by 1,403
“Those patients with a long duration of diabetes, a known history of hypoglycemia, advanced atherosclerosis, or advanced age/frailty may benefit from less aggressive targets (64,65).”
BackgroundChrvala, C. A., Sherr, D., & Lipman, R. D. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2015.11.003 · Cited by 914
“Notwithstanding the potential of tight glycemic control to reduce complications [7], heightened awareness that tighter glycemic control with antihyperglycemic medication can be associated with increased risk of hyperglycemia [8] suggested that a current review of the potential for clinical benefit from DSME which exam…”
6. Glycemic Targets: Standards of Medical Care in Diabetes—2021
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s006 · Cited by 847
“advanced atherosclerosis, or advanced age/frailty may benefit from less aggressive targets (55,56).”
Background6. Glycemic Targets: Standards of Medical Care in Diabetes—2018
American Diabetes Association (2017) · Diabetes Care · doi:10.2337/dc18-s006 · Cited by 784
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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