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Few data exist examining the management of elderly patients with type 2 diabetes mellitus and renal impairment RI. This observational study assessed the therapeutic management of this fragile population. Patients had a mean age of 81 years range 75โ with long-standing diabetes Mean hemoglobin A 1c was 7.
Treatments were adjusted to increasing RI, with less use of metformin, sulfonylureas, and DPP-4 inhibitors, and more glinides and insulin in severe RI. Only one-fourth were under oral monotherapy. In clinical practice, a substantial proportion of elderly patients may be overtreated.
RI is insufficiently taken into account when prescribing OAD. Keywords: elderly, hypoglycemia, overtreatment, renal impairment, sulfonylureas, type 2 diabetes mellitus. Elderly diabetic patients constitute a markedly heterogeneous population, in whom individualization of treatment is especially important. Despite the high prevalence and significant burden of the disease in the elderly population, few data are available from randomized clinical trials or from real-life experience in elderly patients with diabetes and comorbidities.
On one hand, this dearth of evidence could lead to under-treatment in this population, 11 but on the other hand the possibility of overtreatment of these vulnerable individuals at high risk of adverse hypoglycemic events also has to be considered. Details of the study design are described elsewhere. All were outpatients, thus probably without significant mobility or cognitive impairments, but frailty was not formally assessed. Sociodemographic, clinical, and biological data were collected during the single study visit and included: age, sex, disease history, comorbidities, diabetes complications, CV risk factors and concomitant therapies, available biological data including HbA 1c and urinary albumin excretion rate UAER no test was required by the protocol in this observational study , and current anti-diabetic treatments by therapeutic classes.
