Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study
Alfred Penfornis,1 Béatrice Fiquet,2 Jean Frédéric Blicklé,3 Sylvie Dejager2,4 1Department of Endocrinology and Diabetology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes Cedex, France; 2Clinical Affairs, Novartis Pharma SAS, Rueil-Malmaison, France;...
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Dove Medical Press
2015
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oai:doaj.org-article:bb8072dd804b401599ecb9e812fc86162021-12-02T10:59:00ZPotential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study1178-7007https://doaj.org/article/bb8072dd804b401599ecb9e812fc86162015-07-01T00:00:00Zhttp://www.dovepress.com/potential-glycemic-overtreatment-in-patients-ge75-years-with-type-2-di-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Alfred Penfornis,1 Béatrice Fiquet,2 Jean Frédéric Blicklé,3 Sylvie Dejager2,4 1Department of Endocrinology and Diabetology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes Cedex, France; 2Clinical Affairs, Novartis Pharma SAS, Rueil-Malmaison, France; 3Department of Internal Medicine and Diabetology, Strasbourg University Hospital, Strasbourg, France; 4Department of Diabetology, Metabolism and Endocrinology, Pitié-Salpétrière Hospital, Paris, France Background: Few data exist examining the management of elderly patients with type 2 diabetes mellitus and renal impairment (RI). This observational study assessed the therapeutic management of this fragile population. Methods: Cross-sectional study: data from 980 diabetic patients ≥75 years with renal disease are presented. Results: Patients had a mean age of 81 years (range 75–101) with long-standing diabetes (15.4 years) often complicated (half with macrovascular disease). Mean estimated glomerular filtration rate was 43 mL/min/1.73 m2 and 20% had severe RI. Mean hemoglobin A1c was 7.4%. Anti-diabetic therapy was oral based for 51% of patients (60% $2 oral anti-diabetic drugs [OAD]) and insulin based for 49% (combined with OAD in 59%). OAD included metformin (47%), sulfonylureas (26%), glinides (19%), and DPP-4 inhibitors (31%). Treatments were adjusted to increasing RI, with less use of metformin, sulfonylureas, and DPP-4 inhibitors, and more glinides and insulin in severe RI. In all, 579 (60%) of these elderly patients with comorbidities had hemoglobin A1c <7.5% (mean 6.7%) while being intensively treated: 69% under insulin-secretagogues and/or insulin, putting them at high risk for severe hypoglycemia. Only one-fourth were under oral monotherapy. Conclusion: In clinical practice, a substantial proportion of elderly patients may be overtreated. RI is insufficiently taken into account when prescribing OAD. Keywords: elderly, hypoglycemia, overtreatment, renal impairment, sulfonylureas, type 2 diabetes mellitusPenfornis AFiquet BBlicklé JFDejager SDove Medical PressarticleSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol 2015, Iss default, Pp 303-313 (2015) |
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Specialties of internal medicine RC581-951 |
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Specialties of internal medicine RC581-951 Penfornis A Fiquet B Blicklé JF Dejager S Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study |
| description |
Alfred Penfornis,1 Béatrice Fiquet,2 Jean Frédéric Blicklé,3 Sylvie Dejager2,4 1Department of Endocrinology and Diabetology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes Cedex, France; 2Clinical Affairs, Novartis Pharma SAS, Rueil-Malmaison, France; 3Department of Internal Medicine and Diabetology, Strasbourg University Hospital, Strasbourg, France; 4Department of Diabetology, Metabolism and Endocrinology, Pitié-Salpétrière Hospital, Paris, France Background: Few data exist examining the management of elderly patients with type 2 diabetes mellitus and renal impairment (RI). This observational study assessed the therapeutic management of this fragile population. Methods: Cross-sectional study: data from 980 diabetic patients ≥75 years with renal disease are presented. Results: Patients had a mean age of 81 years (range 75–101) with long-standing diabetes (15.4 years) often complicated (half with macrovascular disease). Mean estimated glomerular filtration rate was 43 mL/min/1.73 m2 and 20% had severe RI. Mean hemoglobin A1c was 7.4%. Anti-diabetic therapy was oral based for 51% of patients (60% $2 oral anti-diabetic drugs [OAD]) and insulin based for 49% (combined with OAD in 59%). OAD included metformin (47%), sulfonylureas (26%), glinides (19%), and DPP-4 inhibitors (31%). Treatments were adjusted to increasing RI, with less use of metformin, sulfonylureas, and DPP-4 inhibitors, and more glinides and insulin in severe RI. In all, 579 (60%) of these elderly patients with comorbidities had hemoglobin A1c <7.5% (mean 6.7%) while being intensively treated: 69% under insulin-secretagogues and/or insulin, putting them at high risk for severe hypoglycemia. Only one-fourth were under oral monotherapy. Conclusion: In clinical practice, a substantial proportion of elderly patients may be overtreated. RI is insufficiently taken into account when prescribing OAD. Keywords: elderly, hypoglycemia, overtreatment, renal impairment, sulfonylureas, type 2 diabetes mellitus |
| format |
article |
| author |
Penfornis A Fiquet B Blicklé JF Dejager S |
| author_facet |
Penfornis A Fiquet B Blicklé JF Dejager S |
| author_sort |
Penfornis A |
| title |
Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study |
| title_short |
Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study |
| title_full |
Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study |
| title_fullStr |
Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study |
| title_full_unstemmed |
Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study |
| title_sort |
potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational oredia study |
| publisher |
Dove Medical Press |
| publishDate |
2015 |
| url |
https://doaj.org/article/bb8072dd804b401599ecb9e812fc8616 |
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