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 HbA1c<7.0% (fixed proxy-definition) or as HbA1c<7.0%, 7.5% and 8.0% according to patient’s health status (individualized proxy-definition). The primary outcome was time-below-range (TBR)≥1%. RESULTS 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.