Diabetes Overtreatment and Hypoglycemia in Older Patients with type 2 Diabetes on Insulin Therapy: Insights from the HYPOAGE Cohort study

OBJECTIVE To assess the accuracy of “diabetes overtreatment” proxy-definitions in predicting hypoglycemia in older adults with type 2 diabetes (T2D).RESEARCH DESIGN AND METHODS Inclusion of patients from HYPOAGE cohort with insulin-treated T2D, aged ≥75 years, and using a continuous glycemic monitoring (CGM) device for 28 days. “Diabetes overtreatment” was defined as HbA1cRESULTS Of the 134 patients included (81.6±5.4 years, 59% male), 25 (19%) and 53 (40%) were overtreated, based on fixed and individualized proxy-definitions, respectively. CGM data showed TBR>1% in nearly all patients regardless of overtreatment status. Both proxy-definitions had low sensitivity (20% 14%;29% and 41% 32%;50%) and accuracy (27% 20%;35% and 44% 35%;53%) in predicting hypoglycemia. CONCLUSIONS A revised definition of diabetes overtreatment is needed to better manage older insulin-treated patients and protect them from hypoglycemia.