36OVERTREATMENT OF TYPE 2 DIABETES IN OLDER PEOPLE LIVING IN CARE HOMES IN UNITED KINGDOM

Abstract

Introduction: In the United Kingdom, fifty percent of older people entering care homes die within fifteen months. For older people with multiple co-morbidities and a short life expectancy, intensive treatment of Type 2 Diabetes does not improve outcomes and may cause harm with increased risk of mortality and hypoglycaemia. National guidance recommends that HbA1c targets may be relaxed on an individual basis for frail older patients but does not provide advice on how to do so. American Diabetes Association (ADA) guidelines provide a framework for HbA1c targets in older patients, depending on frailty and co-morbidities. Methods: We reviewed the patient records of patients over 80 years old discharged after July 2015 and recorded co-morbidities, most recent HbA1c level and current diabetes treatment. Based on ADA guidelines, we used a definition of overtreatment as 'HbA1c < 53 and on a hypoglycaemic' and 'HbA1c 53-63 and either (i) three or more co-morbidities or (ii) dementia/falls/end of life and on hypoglycaemic'. Results: In total 113 cases were reviewed. Based on ADA guidance, 38% of patients were being over-treated for Type 2 Diabetes. Key Conclusions: A significant proportion of frail older people with type 2 diabetes admitted from care homes in Leeds were over-treated, increasing the risk of adverse events. Addressing this could lead to benefits in terms of patient safety and hospital admissions.