Minimising harms of tight glycaemic control in older patients with type 2 diabetes
In older adults with type 2 diabetes (T2DM), tight glycaemic control (HbA1c 7%) can result in more harm than benefit, especially when using insulin or sulfonylureas. Older adults are at higher risk for adverse drug events, especially hypoglycaemia, which may cause falls, confusion and hospitalisati...
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AOSIS
2024-12-01
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| Series: | African Journal of Primary Health Care & Family Medicine |
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| Online Access: | https://phcfm.org/index.php/phcfm/article/view/4857 |
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| author | Wade Thompson |
| author_facet | Wade Thompson |
| author_sort | Wade Thompson |
| collection | DOAJ |
| description | In older adults with type 2 diabetes (T2DM), tight glycaemic control (HbA1c 7%) can result in more harm than benefit, especially when using insulin or sulfonylureas. Older adults are at higher risk for adverse drug events, especially hypoglycaemia, which may cause falls, confusion and hospitalisations. This Therapeutic Letter evaluates the risks of tight glycaemic control in older adults with T2DM, focusing on deprescribing diabetes medications in those over 65, especially those with multimorbidity and polypharmacy. It assesses the evidence from clinical trials and guidelines, with a focus on preventing hypoglycaemia and improving patient-centred care through relaxed HbA1c targets. Large randomised controlled trials show that intensive glycaemic control (HbA1c ≤ 7%) does not reduce cardiovascular risk, but increases hypoglycaemia and mortality, particularly in older adults. Instead, glycaemic targets should be adjusted based on the patient’s overall health and life expectancy. Deprescribing may be considered, starting with drugs most likely to cause hypoglycaemia (sulfonylureas or insulin). Regular reassessment and patient involvement in creating individualised treatment plans are essential. |
| format | Article |
| id | doaj-art-eebc4cd088db4e57baae71487a4181de |
| institution | Kabale University |
| issn | 2071-2928 2071-2936 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | AOSIS |
| record_format | Article |
| series | African Journal of Primary Health Care & Family Medicine |
| spelling | doaj-art-eebc4cd088db4e57baae71487a4181de2025-01-14T12:13:42ZengAOSISAfrican Journal of Primary Health Care & Family Medicine2071-29282071-29362024-12-01161e1e410.4102/phcfm.v16i1.48571213Minimising harms of tight glycaemic control in older patients with type 2 diabetesWade Thompson0Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, VancouverIn older adults with type 2 diabetes (T2DM), tight glycaemic control (HbA1c 7%) can result in more harm than benefit, especially when using insulin or sulfonylureas. Older adults are at higher risk for adverse drug events, especially hypoglycaemia, which may cause falls, confusion and hospitalisations. This Therapeutic Letter evaluates the risks of tight glycaemic control in older adults with T2DM, focusing on deprescribing diabetes medications in those over 65, especially those with multimorbidity and polypharmacy. It assesses the evidence from clinical trials and guidelines, with a focus on preventing hypoglycaemia and improving patient-centred care through relaxed HbA1c targets. Large randomised controlled trials show that intensive glycaemic control (HbA1c ≤ 7%) does not reduce cardiovascular risk, but increases hypoglycaemia and mortality, particularly in older adults. Instead, glycaemic targets should be adjusted based on the patient’s overall health and life expectancy. Deprescribing may be considered, starting with drugs most likely to cause hypoglycaemia (sulfonylureas or insulin). Regular reassessment and patient involvement in creating individualised treatment plans are essential.https://phcfm.org/index.php/phcfm/article/view/4857type 2 diabetesolder adultsglycaemic targetshypoglycaemiatherapeutics |
| spellingShingle | Wade Thompson Minimising harms of tight glycaemic control in older patients with type 2 diabetes African Journal of Primary Health Care & Family Medicine type 2 diabetes older adults glycaemic targets hypoglycaemia therapeutics |
| title | Minimising harms of tight glycaemic control in older patients with type 2 diabetes |
| title_full | Minimising harms of tight glycaemic control in older patients with type 2 diabetes |
| title_fullStr | Minimising harms of tight glycaemic control in older patients with type 2 diabetes |
| title_full_unstemmed | Minimising harms of tight glycaemic control in older patients with type 2 diabetes |
| title_short | Minimising harms of tight glycaemic control in older patients with type 2 diabetes |
| title_sort | minimising harms of tight glycaemic control in older patients with type 2 diabetes |
| topic | type 2 diabetes older adults glycaemic targets hypoglycaemia therapeutics |
| url | https://phcfm.org/index.php/phcfm/article/view/4857 |
| work_keys_str_mv | AT wadethompson minimisingharmsoftightglycaemiccontrolinolderpatientswithtype2diabetes |