Adherence to the American Diabetes Association’s glycemic goals in the treatment of diabetes among older americans, 2001-2018
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Abstract
OBJECTIVE: To assess trends in HbA1c and appropriateness of diabetes medication use by patient health status. RESEARCH DESIGN AND METHODS: We conducted cross-sectional analysis of 2001–2018 National Health and Nutrition Examination Survey (NHANES). We included older adults age ≥65 years who had ever been told they had diabetes, had HbA1c >6.4%, or had fasting plasma glucose >125 mg/dL. Health status was categorized as good, intermediate, or poor. Being below goal was defined as taking medication despite having HbA1c ≥1% below the glycemic goals of the American Diabetes Association (ADA), which varied by patient health status and time period. Drugs associated with hypoglycemia included sulfonylureas, insulin, and meglitinides. RESULTS: We included 3,539 patients. Mean HbA1c increased over time and did not differ by health status. Medication use increased from 59% to 74% with metformin being the most common drug in patients with good or intermediate health and sulfonylureas and insulin most often prescribed to patients with poor health. Among patients taking medications, prevalence of patients below goal increased while prevalence of those above goal decreased from 2001 to 2018. One-half of patients with poor health and taking medications had below-goal HbA1c; two-thirds received drugs associated with hypoglycemia. Patients with poor health who were below goal had 4.9 (95% CI 2.3–10.4) times the adjusted odds of receiving drugs associated with hypoglycemia than healthy patients. CONCLUSIONS: In accordance with ADA’s newer Standards of Medical Care in Diabetes, HbA1c goals were relaxed but did not differ by health status. Below-goal HbA1c was common among patients with poor health; many were prescribed medications associated with a higher risk of hypoglycemia.
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Older adults with diabetes categorized as having complex or intermediate health are heterogeneous with respect to their function and life expectancy.
“Older adults with diabetes categorized as having complex or intermediate health (Table 13.1) are heterogeneous with respect to their function and life expectancy (61)(62)(63).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [63]
The Ascertainment of Health Status section defines intermediate health through several different criteria—chronic illnesses, instrumental ADL impairments, or cognitive impairment—supporting variation in function within that group. It discusses limited life expectancy as a criterion for poor health, but does not establish that life expectancy varies within the intermediate group. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOlder adults with diabetes categorized as having complex or intermediate health are heterogeneous with respect to their function and life expectancy.
“Older adults with diabetes categorized as having complex or intermediate health (Table 13.2) are still heterogeneous with respect to their function and life expectancy”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [71]
The Ascertainment of Health Status section defines intermediate health through several alternative criteria, and Table 1 (displayed under Conclusions) shows variation in functional impairments within that group. The paper uses limited life expectancy to identify poor health, but the passages do not establish variation in life expectancy among those classified as intermediate. Page numbers are unavailable in our copy. (LLM, conf=0.84)
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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
- Authors
- Le, P., Ayers, G., Misra-Hebert, A. D., Herzig, S. J., Herman, W. H., Shaker, V. A., & Rothberg, M. B.
- Affiliations
- Cleveland Clinic (US)
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH
- Beth Israel Deaconess Medical Center (US)
- University of Michigan (US)
- Corresponding author
- Le, Phuc
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2022-01-25
- Volume
- 45
- Issue
- 5
- Pages
- 1107-1115
- ISSN
- 0149-5992 (ISSN-L)
- OpenAlex
- W4206918068
- Cited by
- 26
- References
- 9
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 5 · 2023: 5 · 2022: 7
- FWCI
- 3.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (K08 HS024128)
- 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
- glycemic control, HbA1c, glycemic targets, older adults, diabetes medication use, hypoglycemia, sulfonylureas, insulin, metformin, health status, NHANES
- MeSH terms
- Aged, Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Goals, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Nutrition Surveys, Sulfonylurea Compounds, United States
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