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Tight glycemic control and use of hypoglycemic medications in older veterans with type 2 diabetes and comorbid dementia

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Thorpe, Carolyn T., Gellad, Walid F., Good, Chester B., Zhang, Sijian, Zhao, Xinhua, Mor, Maria, Fine, Michael J.·2015·Diabetes Care
DOI 10.2337/dc14-0599PMC PMC5447267
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Abstract

OBJECTIVE: Older adults with diabetes and dementia are at increased risk for hypoglycemia and other adverse events associated with tight glycemic control and are unlikely to experience long-term benefits. We examined risk factors for tight glycemic control in this population and use of medications associated with a high risk of hypoglycemia in the subset with tight control. RESEARCH DESIGN AND METHODS: This retrospective cohort study of national Veterans Affairs (VA) administrative/clinical data and Medicare claims for fiscal years (FYs) 2008–2009 included 15,880 veterans aged ≥65 years with type 2 diabetes and dementia and prescribed antidiabetic medication. Multivariable regression analyses were used to identify sociodemographic and clinical predictors of hemoglobin A1c (HbA1c) control (tight, moderate, poor, or not monitored) and, in patients with tight control, subsequent use of medication associated with a high risk of hypoglycemia (sulfonylureas, insulin). RESULTS: Fifty-two percent of patients had tight glycemic control (HbA1c <7% [53 mmol/mol]). Specific comorbidities, older age, and recent weight loss were associated with greater odds of tight versus moderate control, whereas Hispanic ethnicity and obesity were associated with lower odds of tight control. Among tightly controlled patients, 75% used sulfonylureas and/or insulin, with higher odds in patients who were male, black, or aged ≥75 years; had a hospital or nursing home stay in FY2008; or had congestive heart failure, renal failure, or peripheral vascular disease. CONCLUSIONS: Many older veterans with diabetes and dementia are at high risk for hypoglycemia associated with intense diabetes treatment and may be candidates for deintensification or alteration of diabetes medications.

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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 [103]

    The Introduction says older adults with dementia should generally avoid tight glycemic control, and the Results report that 75% of tightly controlled patients used insulin and/or sulfonylureas. The Conclusions call for deintensification but also note that tighter targets or insulin may be appropriate for some patients. The study focuses on older veterans with dementia, so it does not establish that these regimens are invariably overtreatment across all older adults with complex medical conditions. Our copy provides no page numbers for these passages. (LLM, conf=0.84)

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  • Intensive 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 [103]

    The Results (Sample Characteristics; page not provided) report that 75% of tightly controlled patients used insulin and/or sulfonylureas, and the Conclusions describe a high rate of intense treatment in older patients with dementia. The evidence comes from a cohort of older veterans with diabetes and comorbid dementia, so it does not establish that this pattern is very common across all older adults with complex medical conditions. The paper also notes that tighter targets or insulin may be appropriate for some patients, rather than classifying every such regimen as overtreatment. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Intensive 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 [112]

    The Results and Conclusions (page not available in our copy) show that tight glycemic control was common among older veterans with diabetes and dementia, and that 75% of tightly controlled patients used insulin and/or sulfonylureas. The paper describes this combination as a concern warranting possible deintensification, but its findings do not establish how common it is among older adults with complex health status generally. It also notes that tighter targets or insulin may be appropriate for some patients, so it does not classify every such regimen as overtreatment. (LLM, conf=0.85)

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Cites

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Research works printed but not linked: 23

  1. [2]Feil DG, Rajan M, Soroka O, Tseng CL, Miller DR, Pogach LM Risk of hypoglycemia in older veterans with dementia and cognitive impairment: implications for practice and policy. J Am Geriatr Soc 2011; 59: 2263– 2272 22150156
  2. [3]Thorpe CT, Thorpe JM, Kind AJ, Bartels CM, Everett CM, Smith MA Receipt of monitoring of diabetes mellitus in older adults with comorbid dementia. J Am Geriatr Soc 2012; 60: 644– 651 22428535 PMC3325373
  3. [4]Yaffe K, Falvey CM, Hamilton N,.; Health ABC Study Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med 2013; 173: 1300– 1306 23753199 PMC4041621
  4. [5]Yaffe K, Falvey C, Hamilton N, Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia. Arch Neurol 2012; 69: 1170– 1175 22710333 PMC3752423
  5. [6]Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol 2006; 5: 64– 74 16361024
  6. [8]Bynum JP, Rabins PV, Weller W, Niefeld M, Anderson GF, Wu AW The relationship between a dementia diagnosis, chronic illness, Medicare expenditures, and hospital use. J Am Geriatr Soc 2004; 52: 187– 194 14728626
  7. [9]Onder G, Landi F, Fusco D, Recommendations to prescribe in complex older adults: results of the CRIteria to assess appropriate Medication use among Elderly complex patients (CRIME) project. Drugs Aging 2014; 31: 33– 45 24234805
  8. [10]Feil DG, Zhu CW, Sultzer DL The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with type 2 diabetes. J Behav Med 2012; 35: 190– 199 21503710
  9. [11]Kirsh SR, Aron DC Choosing targets for glycaemia, blood pressure and low-density lipoprotein cholesterol in elderly individuals with diabetes mellitus. Drugs Aging 2011; 28: 945– 960 22117094
  10. [12]Hewitt J, Smeeth L, Chaturvedi N, Bulpitt CJ, Fletcher AE Self management and patient understanding of diabetes in the older person. Diabet Med 2011; 28: 117– 122 21166853 PMC3588140
  11. [13]Briscoe VJ, Davis SN Hypoglycemia in type 1 and type 2 diabetes: physiology, pathophysiology, and management. Clin Diabetes 2006; 24: 115– 121
  12. [14]Xie J, Brayne C, Matthews FE; Medical Research Council Cognitive Function and Ageing Study Collaborators Survival times in people with dementia: analysis from population based cohort study with 14 year follow-up. BMJ 2008; 336: 258– 262 18187696 PMC2223023
  13. [15]Williams MM, Xiong C, Morris JC, Galvin JE Survival and mortality differences between dementia with Lewy bodies vs Alzheimer disease. Neurology 2006; 67: 1935– 1941 17159097
  14. [20]Moreno G, Mangione CM, Kimbro L, Vaisberg E; American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 update. J Am Geriatr Soc 2013; 61: 2020– 2026 24219204 PMC4064258
  15. [22]Pogach L, Aron D The other side of quality improvement in diabetes for seniors: a proposal for an overtreatment glycemic measure. Arch Intern Med 2012; 172: 1510– 1512 22965316
  16. [23]Gellad W, Mor M, Zhao X, Donohue J, Good C Variation in use of high-cost diabetes mellitus medications in the VA healthcare system. Arch Intern Med 2012; 172: 1608– 1609 23044980
  17. [24]Gellad WF, Donohue JM, Zhao X, Brand-name prescription drug use among Veterans Affairs and Medicare Part D patients with diabetes: a national cohort comparison. Ann Intern Med 2013; 159: 105– 114 23752663 PMC3787067
  18. [25]Miller DR, Safford MM, Pogach LM Who has diabetes? Best estimates of diabetes prevalence in the Department of Veterans Affairs based on computerized patient data. Diabetes Care 2004; 27(Suppl. 2): B10– B21 15113777
  19. [27]Taylor DH Jr., Østbye T, Langa KM, Weir D, Plassman BL The accuracy of Medicare claims as an epidemiological tool: the case of dementia revisited. J Alzheimers Dis 2009; 17: 807– 815 19542620 PMC3697480
  20. [28]Eicheldinger C, Bonito A More accurate racial and ethnic codes for Medicare administrative data. Health Care Financ Rev 2008; 29: 27– 42 18567241 PMC4195038
  21. [30]Klabunde CN, Potosky AL, Legler JM, Warren JL Development of a comorbidity index using physician claims data. J Clin Epidemiol 2000; 53: 1258– 1267 11146273
  22. [31]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
  23. [32]Byrne MM, Kuebeler M, Pietz K, Petersen LA Effect of using information from only one system for dually eligible health care users. Med Care 2006; 44: 768– 773 16862039

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Sorted by citations

Authors
Thorpe, C. T., Gellad, W. F., Good, C. B., Zhang, S., Zhao, X., Mor, M., & Fine, M. J.
Affiliations
  • University of Pittsburgh (US)
  • VA Pittsburgh Healthcare System (US)
Corresponding author
Thorpe, Carolyn T.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2015-01-15
Volume
38
Issue
4
Pages
588-595
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc14-0599
PMC
PMC5447267
OpenAlex
W2093295645
Cited by
140
References
4
Citations by year
2026: 3 · 2025: 5 · 2024: 10 · 2023: 5 · 2022: 27 · 2021: 10 · 2020: 16 · 2019: 17 · 2018: 13 · 2017: 17 · 2016: 14 · 2015: 3
FWCI
13.62
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/site/license (vor, 259 d)
Locations
  • Diabetes Care (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
U.S. Department of Veterans Affairs (CDA 09-207, CIN 13-405)
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
tight glycemic control, hypoglycemia, type 2 diabetes, dementia, older veterans, HbA1c, sulfonylureas, insulin, antidiabetic drugs, risk factors, treatment deintensification, comorbidities, Hispanic origin, obesity
MeSH terms
Adult, Age Factors, Aged, Aged, 80 and over, Blood Glucose, Dementia, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Longitudinal Studies, Male, Retrospective Studies, Risk Factors, Sulfonylurea Compounds, United States, Veterans, Comorbidity

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