Use of intensive glycemic management in older adults with diabetes mellitus
Open accessAbstract
Objectives: To examine the proportion of older adults with diabetes mellitus treated with tight glucose control and the factors associated with this practice. Design: Cross‐sectional analysis. Setting: Outpatient sites in the Diabetes Collaborative Registry (N=151). Participants: Adults aged 75 and older with type 2 diabetes mellitus (N=42,669). Measurements: Participants were categorized based on glycosylated hemoglobin (HbA1c) and glucose‐lowering medications: poor control (HbA1c >9%), moderate control (HbA1c 8–9%), conservative control (HbA1c 7–8%), tight control (HbA1c <7%) with low‐risk agents (low risk for hypoglycemia), tight control with high‐risk agents, and diet control (HbA1c <7% taking no glucose‐lowering medications). We used hierarchical logistic regression to examine participant and site factors associated with tight control and high‐risk agents versus conservative or tight control and low‐risk agents. Results: Of 30,696 participants without diet‐controlled diabetes, 5,596 (18%) had moderate or poor control, 9,227 (30%) had conservative control, 7,893 (26%) had tight control taking low‐risk agents, and 7,980 (26%) had tight control taking high‐risk agents. Older age, male sex, heart failure, chronic kidney disease, and coronary artery disease were each independently associated with greater odds of tight control with high‐risk agents. There were no differences according to practice specialty (endocrinology, primary care, cardiology) in how aggressively participants were managed. Conclusion: One‐quarter of U.S. older adults with type 2 diabetes mellitus are tightly controlled with glucose‐lowering medications that have a high risk of hypoglycemia. These results suggest potential overtreatment of a substantial proportion of people and should encourage further efforts to translate guidelines to daily practice.
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Intensive glycemic management with medication plans including insulin and sulfonylureas in older adults with complex medical conditions has been identified as overtreatment.
“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 [100]
The Discussion reports that tight control with high-risk medications was common in older adults with comorbidities and identifies insulin and sulfonylureas among the medications used. It says these results suggest *potential* overtreatment, however, rather than establishing that every such medication plan is overtreatment. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIntensive glycemic management with insulin and sulfonylureas in older adults with complex medical conditions is very common in clinical practice.
“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 [100]
The Results and Discussion (pages unavailable) report that 26% of older patients whose diabetes was not diet-controlled received tight control with high-risk medications, and that comorbidities were associated with greater use. The Discussion specifically mentions insulin and sulfonylureas in patients with comorbidities. However, the citing sentence calls this overtreatment definitively, whereas the paper says its findings suggest *potential* overtreatment. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIntensive glycemic management in older adults with complex health status and medication plans that increase hypoglycemia risk through insulin and/or sulfonylureas has been identified as overtreatment and is common in clinical practice.
“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 [109]
The Discussion (page unavailable) reports that about a quarter of older adults in the outpatient cohort had tight glucose control while taking medications with a high risk of hypoglycemia, and that comorbidities were associated with greater use of this approach. It names insulin and sulfonylureas, but describes the finding as suggesting *potential* overtreatment, not as establishing that every such treatment plan is overtreatment. (LLM, conf=0.87)
Experimental — accuracy not yet measuredOral agents may achieve glycemic outcomes similar to basal insulin in LTC populations.
“Oral agents may achieve glycemic outcomes similar to basal insulin in LTC populations (93,129).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [93]
The Methods and Results (pages unavailable) describe an outpatient cohort and group patients by HbA1c and medication risk. Searches for long-term care, oral agents, and basal-insulin comparisons found no passage assessing whether oral agents achieve similar glycemic outcomes to basal insulin in LTC residents. (LLM, conf=0.77)
Experimental — accuracy not yet measuredOral agents may achieve glycemic outcomes similar to basal insulin in PALTC populations.
“Oral agents may achieve glycemic outcomes similar to basal insulin in PALTC populations (100,148).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [100]
The Methods (page unavailable) classify patients by HbA1c and medication risk, and the Discussion describes an outpatient cohort. Searches for basal insulin, oral-agent comparisons, and post-acute or long-term care found no passage assessing whether oral agents achieve similar glycemic outcomes to basal insulin in PALTC populations. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Oral agents may achieve glycemic outcomes similar to those for basal insulin in PALTC residents with type 2 diabetes.
“Oral agents may achieve glycemic outcomes similar to those for basal insulin in PALTC residents with type 2 diabetes (109,167).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [109]
The Methods and Results classify older outpatients by HbA1c and medication risk, but do not compare oral agents with basal insulin. A search for basal insulin and post-acute or long-term care found no passage addressing glycemic outcomes in PALTC residents. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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Cites
Potential overtreatment of diabetes mellitus in older adults with tight glycemic control
Lipska, K. J., Ross, J. S., Miao, Y., Shah, N. D., Lee, S. J., & Steinman, M. A. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.7345 · Cited by 408 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 13
- [1]Kirkman MS, Briscoe VJ, Clark N, Diabetes in older adults. Diabetes Care. 2012; 35: 2650– 2664. 23100048 PMC3507610
- [2]Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008; 359: 1577– 1589. 18784090
- [3]Ismail-Beigi F, Moghissi E, Tiktin M, Hirsch IB, Inzucchi SE, Genuth S. Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann Intern Med. 2011; 154: 554– 559. 21502652
- [4]American Diabetes Association. Standards of Medical Care in Diabetes-2017: Pharmacologic Approaches to Glycemic Treatment. Diabetes Care. 40: S64– S74. 27979895
- [5]Action to Control Cardiovascular Risk in Diabetes Study G, Gerstein HC, Miller ME, Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358: 2545– 2559. 18539917 PMC4551392
- [7]Sinclair AJ, Paolisso G, Castro M, European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab. 2011; 37 Suppl 3: S27– 38. 22183418
- [9]Tseng CL, Soroka O, Maney M, Aron DC, Pogach LM. Assessing potential glycemic overtreatment in persons at hypoglycemic risk. JAMA Intern Med. 2014; 174: 259– 268. 24322626
- [10]Sussman JB, Kerr EA, Saini SD, Rates of Deintensification of Blood Pressure and Glycemic Medication Treatment Based on Levels of Control and Life Expectancy in Older Patients With Diabetes Mellitus. JAMA Intern Med. 2015; 175: 1942– 1949. 26502220 PMC9617259
- [11]Arnold SV, Inzucchi SE, McGuire DK, Evaluating the Quality of Comprehensive Cardiometabolic Care for Patients With Type 2 Diabetes in the U.S.: The Diabetes Collaborative Registry. Diabetes Care. 2016; 39: e99– e101. 27222504
- [12]Caverly TJ, Fagerlin A, Zikmund-Fisher BJ, Appropriate Prescribing for Patients With Diabetes at High Risk for Hypoglycemia: National Survey of Veterans Affairs Health Care Professionals. JAMA Intern Med. 2015; 175: 1994– 1996. 26502113
- [13]Boulin M, Diaby V, Tannenbaum C. Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada. PLoS One. 2016; 11: e0162951. PMC5029920 27648831
- [14]Goto A, Arah OA, Goto M, Terauchi Y, Noda M. Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ. 2013; 347: f4533. 23900314
- [15]Lipska KJ, Ross JS, Wang Y, National trends in US hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999 to 2011. JAMA Intern Med. 2014; 174: 1116– 1124. 24838229 PMC4152370
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13. Older Adults: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s013 · Cited by 381 · see citing works
13. Older Adults: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s013 · Cited by 209 · see citing works
13. Older Adults: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Hilliard, M. E., Johnson, E. L., Khunti, K., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s013 · Cited by 161 · see citing works
13. Older Adults: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s013 · Cited by 87 · see citing works
McCoy, R. G., Lipska, K. J., Van Houten, H. K., & Shah, N. D. (2020) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2019-001007 · Cited by 51 · see citing works
Self-citationLega, 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 · see citing works
- Authors
- Arnold, S. V., Lipska, K. J., Wang, J., Seman, L., Mehta, S. N., & Kosiborod, M.
- Affiliations
- Saint Luke's Hospital (US)
- Yale University (US)
- Boehringer Ingelheim (United States) (US)
- Joslin Diabetes Center (US)
- Corresponding author
- Arnold, Suzanne V.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2018-04-10
- Volume
- 66
- Issue
- 6
- Pages
- 1190-1194
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC7032960
- OpenAlex
- W2797967435
- Cited by
- 74
- References
- 1
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 8 · 2022: 11 · 2021: 9 · 2020: 14 · 2019: 9 · 2018: 5
- FWCI
- 7.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- AstraZeneca
- Boehringer Ingelheim
- 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
- tight glycemic control, type 2 diabetes, older adults, HbA1c, hypoglycemia risk, glucose-lowering medications, overtreatment, heart failure, chronic kidney disease, coronary artery disease, diabetes management practices
- MeSH terms
- Aged, Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Diet, Diabetic, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Male, United States, Risk Assessment, Risk Adjustment
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