Overbehandeling van oudere patiënten met diabetes mellitus type 2 in de eerste lijn*

Objective

To assess the extent to which patients with type 2 diabetes mellitus who are at least 70 years old are being treated using personalised HbA1c target values according to the ‘Type 2 diabetes mellitus’ NHG standard, focusing on overtreatment.

Design

Observational study.

Method

Healthcare data of 1002 patients with type 2 diabetes at 5 health centres were routinely collected. Patients ≥ 70 years old were classified into 3 subgroups on the basis of their HbA1c target values (53, 58 and 64 mmol/mol) and we defined ‘overtreatment’ for each subgroup. Within the study population, various subgroups were compared with each other: < 70 years old with ≥ 70 years old, HbA1c target value ≤ 53 mmol/mol with target value > 53 mmol/mol, and on-target patients with overtreated and undertreated patients.

Results

Of 319 patients ≥ 70 years old; a third had diabetes for 10 years or longer. The 165 patients with an HbA1c target value > 53 mmol/mol more often had microvascular complications (54.0% vs 35.2%) and macrovascular complications (33.3% vs 17.7%). They more often used ≥ 5 drugs (87.3% vs 53.2%) and were frail more often (44.2% vs. 13.9%) compared to those with an HbA1c target value of ≤ 53 mmol/mol. Of these 165 patients 64 (38.8%) were overtreated, i.e. 20% of all patients ≥ 70 years old. The majority of overtreated people was frail and used ≥ 5 drugs. 1 in 5 reported hypoglycaemia and almost 30% had reported a fall.

Conclusion

Personalized treatment in older people with type 2 diabetes is not properly practised yet. A substantial number of older people are overtreated, with potential harmful consequences. Defining a lower limit for HbA1c could help prevent overtreatment. Outcome indicators in the form of averages per practice or care group are not very useful.

Conflict of interest and financial support: potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.