Year: 2024
Type: article
Abstract: Background: In older adults with type 2 diabetes (T2DM), tight glycemic 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 hypoglycemia, which may cause falls, confusion, and hospitalizations. Aims: This Therapeutics Letter evaluates the risks of tight glycemic control in older adults with T2DM, focusing on deprescribing diabetes medications in those over 65, especially those with multimorbidities and polypharmacy. It assesses the evidence from clinical trials and guidelines, with a focus on preventing hypoglycemia and improving patient-centered care through relaxed HbA1c targets. Recommendations: Large RCTs show that intensive glycemic control (HbA1c ≤7%) does not reduce cardiovascular risk but increases hypoglycemia and mortality, particularly in older adults. Instead, glycemic 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 hypoglycemia (sulfonylureas or insulin). Regular reassessment and patient involvement in creating individualized treatment plans are essential.
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7210995868