Older People with Type 2 Diabetes, Including Those with Chronic Kidney Disease or Dementia, Are Commonly Overtreated with Sulfonylurea or Insulin Therapies

Aim: To evaluate potential overtreatment with sulfonylurea and insulin therapies amongst older people with Type 2 diabetes, including those with chronic kidney disease or dementia.

Methods: Using the ECLIPSE Live software tool, we developed a search to examine data on older people (age ≥ 70 years) with Type 2 diabetes, who were prescribed sulfonylurea or insulin therapies over the previous 90 days. Sixteen Norfolk general practices participated, representing a population of 24 661 older people, including 3862 (15.7%) with Type 2 diabetes. Of these, 1379 (35.7%) people were prescribed sulfonylurea or insulin therapies. Data extracted included age, sex, last recorded HbA value, renal function and dementia codes.

Results: The median age of the study cohort was 78 years. A total of 644 people (47.8%) had chronic kidney disease (estimated GFR < 60 mL/min/1.73m ) and 60 people (4.35%) had dementia. The median (interquartile range) HbA concentration for the entire cohort was 58 (51-69) mmol/mol [7.5 (6.8-8.5)%], with no difference in median HbA between those with or without either chronic kidney disease or dementia. In total, 400 older people (29.9%) had an HbA concentration < 53 mmol/mol (7%), of whom 162 (12.1%) had HbA < 48 mmol/mol (6.5%). Stratified by prescription for sulfonylurea, insulin or combined insulin and sulfonylurea therapies, 282 (35.2%), 93 (24.2%) and 25 people (16.3%), respectively, had HbA < 53 mmol/mol (7.0%). Treatment to an HbA target of < 53 mmol/mol (7.0%) was as prevalent in those with chronic kidney disease or dementia as in those without.

Conclusion: In the present cohort of older people with Type 2 diabetes prescribed sulfonylurea or insulin therapies, overtreatment was common, even in the presence of comorbidities known to increase hypoglycaemia risk.