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- Title
Decline in use of high‐risk agents for tight glucose control among older adults with diabetes in New York City: 2017–2022.
- Authors
Zhang, Jeff; Kanchi, Rania; Conderino, Sarah; Levy, Natalie K.; Adhikari, Samrachana; Blecker, Saul; Davis, Nichola; Divers, Jasmin; Rabin, Catherine; Weiner, Mark; Thorpe, Lorna; Dodson, John A.
- Abstract
Background: This study aimed to examine the prevalence of inappropriate tight glycemic control in older adults with type 2 diabetes and other chronic conditions in New York City, and to identify factors associated with this practice. Methods: We conducted a retrospective cohort study using the INSIGHT Clinical Research Network. The study population included 11,728 and 15,196 older adults in New York City (age ≥ 75 years) with a diagnosis of type 2 diabetes, and at least one other chronic medical condition, in 2017 and 2022, respectively. The main outcome of interest was inappropriate tight glycemic control, defined as HbA1c <7.0% (<53 mmol/mol) with prescription of at least one high‐risk agent (insulin or insulin secretagogue). Results: The proportion of older adults with inappropriate tight glycemic control decreased by nearly 19% over a five‐year period (19.4% in 2017 to 15.8% in 2022). There was a significant decrease in insulin (27.8% in 2017; 24.3% in 2022) and sulfonylurea (29.4% in 2017; 21.7% in 2022) medication prescription, and increase in use of GLP‐1 agonists (1.8% in 2017; 11.4% in 2022) and SGLT‐2 inhibitors (5.8% in 2017; 25.1% in 2022), among the total population. Factors associated with inappropriate tight glycemic control in 2022 included history of heart failure (adjusted odds ratio [aOR] 1.38), chronic kidney disease ([aOR] 1.93), colorectal cancer ([aOR] 1.38), acute myocardial infarction ([aOR] 1.28), "other" ([aOR] 0.72) or "unknown" ([aOR] 0.72) race, and a point increase in BMI ([aOR] 0.98). Conclusions: We found an encouraging trend toward less use of high‐risk medication strategies for older adults with type 2 diabetes and multiple chronic conditions. However, one in six patients in 2022 still had inappropriate tight glycemic control, indicating a need for continued efforts to optimize diabetes management in this population.
- Subjects
NEW York (State); MYOCARDIAL infarction risk factors; HEART failure risk factors; RISK assessment; GLUCAGON-like peptide-1 agonists; DRUG side effects; GLYCOSYLATED hemoglobin; MEDICAL prescriptions; BODY mass index; RESEARCH funding; GLYCEMIC control; HYPOGLYCEMIC agents; INSULIN; DESCRIPTIVE statistics; COLORECTAL cancer; ODDS ratio; CHRONIC kidney failure; TYPE 2 diabetes; SODIUM-glucose cotransporter 2 inhibitors; INSULIN secretagogues; DISEASE risk factors; OLD age
- Publication
Journal of the American Geriatrics Society, 2024, Vol 72, Issue 9, p2721
- ISSN
0002-8614
- Publication type
Article
- DOI
10.1111/jgs.19060