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Intensive glycemic control and macrovascular, microvascular, hypoglycemia complications and mortality in older (age ≥60years) or frail adults with type 2 diabetes: a systematic review and meta-analysis from randomized controlled trial and observation studies

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Crabtree, Thomas, Ogendo, Jael-Joy, Vinogradova, Yana, Gordon, Jason, Idris, Iskandar·2022·Expert Review of Endocrinology & Metabolism
DOI 10.1080/17446651.2022.2079495
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Abstract

INTRODUCTION: Guidelines for type 2 diabetes (T2D) recommend individualized HbA1c targets to take into account patient age or frailty. We synthesized evidence from randomized controlled trials and observational studies for intensive glycemic control (HbA1c target ≤58 mmol/mol) versus standard care, in elderly (age ≥60 years) or frail adults with T2D. METHODS: Searches were performed utilizing recognized terms for T2D, frailty, older age, and HbA1c control and outcomes of interest. Meta-analysis was performed where possible. Primary outcomes included all-cause mortality, severe hypoglycemia, and hospital admission rates. Vascular complications, cognitive decline, and falls/fractures were secondary outcomes. RESULTS: 7,528 studies were identified of which 15 different clinical studies were selected. No difference was noted in all-cause mortality with intensive control (pooled hazard ratio 0.96, 95% confidence interval 0.90-1.03), but risk of severe hypoglycemia increased (2.45, 2.22-2.72). Intensive control was associated reductions in microvascular (0.73, 0.68-0.79) and macrovascular complications (0.84, 0.79-0.89). Outcome data for risk of hospitalization, cognition, and falls/fractures were limited. CONCLUSION: Intensive glycemic control was associated with reduced rates of complications but increased severe hypoglycemia. Significant heterogeneity exists and the impact of different drug regimens is unclear. Caution is needed when setting glycemic targets in elderly or frail individuals.

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  • In ACCORD, compared with standard care, the intensive glycemic control group had increased hypoglycemia (10.5% vs 3.5%; P < .001), weight gain greater than 10% (28% vs 14%; P < .001), and mortality (5% vs 4%; hazard ratio, 1.22 [95% CI, 1.01-1.46]), prompting early trial discontinuation.

    “In ACCORD, compared with the standard care group, the intensive glycemic control group had increased hypoglycemia (10.5% vs 3.5%; P < .001), weight gain greater than 10% (28% vs 14%; P < .001), and mortality (5% vs 4%; hazard ratio, 1.22 [95% CI, 1.01–1.46]), prompting early trial discontinuation.39,43”

    From Diagnosis and Treatment of Type 2 Diabetes in Adults (2025) · cites this paper as [39]

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Sorted by citations

Authors
Crabtree, T., Ogendo, J.-J., Vinogradova, Y., Gordon, J., & Idris, I.
Affiliations
University of Nottingham (GB)
Corresponding author
Idris, Iskandar
ORCID
Venue
Expert Review of Endocrinology & Metabolism
Publisher
Informa UK Limited
Published
2022-05-04
Volume
17
Issue
3
Pages
255-267
ISSN
  • 1744-6651 (ISSN-L)
  • 1744-8417
DOI
10.1080/17446651.2022.2079495
OpenAlex
W4280612335
Cited by
38
References
2
Citations by year
2026: 13 · 2025: 11 · 2024: 7 · 2023: 4 · 2022: 3
FWCI
0.89
Type
journal article
Language
en
Open access
Licence
Locations
  • Expert Review of Endocrinology & Metabolism (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
Funders
no funding
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 › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
type 2 diabetes, tight glycemic control, HbA1c targets, frailty, older adults, severe hypoglycemia, all-cause mortality, macrovascular complications, microvascular complications, hospitalization, cognitive decline, falls and fractures
MeSH terms
Frailty, Glycemic Control, Adult, Aged, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Middle Aged, Randomized Controlled Trials as Topic, Frail Elderly

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