Tight glycemic control and use of hypoglycemic medications in older veterans with type 2 diabetes and comorbid dementia

Abstract

OBJECTIVE Older adults with diabetes and dementia are at increased risk for hypoglycemia and other adverse events associated with tight glycemic control and are unlikely to experience long-term benefits. We examined risk factors for tight glycemic control in this population and use of medications associated with a high risk of hypoglycemia in the subset with tight control. RESEARCH DESIGN AND METHODS This retrospective cohort study of national Veterans Affairs (VA) administrative/ clinical data and Medicare claims for fiscal years (FYs) 2008-2009 included 15,880 veterans aged ≥65 years with type 2 diabetes and dementia and prescribed antidiabetic medication. Multivariable regression analyses were used to identify sociodemographic and clinical predictors of hemoglobin A1c (HbA1c) control (tight, moderate, poor, or not monitored) and, in patients with tight control, subsequent use ofmedication associated with a high risk of hypoglycemia (sulfonylureas, insulin). RESULTS Fifty-two percent of patients had tight glycemic control (HbA1c <7% [53mmol/mol]). Specific comorbidities, older age, and recent weight loss were associated with greater odds of tight versus moderate control, whereas Hispanic ethnicity and obesity were associated with lower odds of tight control. Among tightly controlled patients, 75% used sulfonylureas and/or insulin, with higher odds in patients who were male, black, or aged ≥75 years; had a hospital or nursing home stay in FY2008; or had congestive heart failure, renal failure, or peripheral vascular disease. CONCLUSIONS Many older veterans with diabetes and dementia are at high risk for hypoglycemia associated with intense diabetes treatment and may be candidates for deintensification or alteration of diabetes medications.