Two-Thirds of Older Diabetics Have Poor Glycemic Control

Only 1 in 3 older adults with diabetes meet the American Diabetes Association’s (ADA) treatment targets for blood glucose, cholesterol, and blood pressure.

In light of these discouraging findings, lead study author Christina M. Parrinello, PhD, MPH, told Pharmacy Times that pharmacists can play an important role in helping older patients manage their diabetes.

For instance, Dr. Parrinello said, pharmacists can monitor treatment history and general health, provide patient education about overtreating or undertreating diabetes, and raise awareness of potential adverse effects from their medications.

“[Pharmacists] can also emphasize to patients the importance of maintaining open lines of communication with their doctor to ensure timely and regular follow-up—especially in this population of older adults, in which individualized treatment targets may be most appropriate,” she said.

Dr. Parrinello and her fellow researchers examined 1574 patients aged 67 to 90 years who were diagnosed with diabetes. In this population, 44% were male and 29% were African-American.

The ADA’s targets for diabetics are:

· Hemoglobin A1C (HbA1C) <7% (<53 mmol/mol)

· Low-density lipoprotein (LDL) cholesterol <100 mg/dL

· Systolic blood pressure (SBP) <140 mm Hg, and

· Diastolic blood pressure (DBP) <90 mm Hg

Because the researchers defined these ADA targets as “stringent,” they also took into consideration some less stringent targets: HbA1c <8% (<64 mmol/mol), LDL cholesterol <130 mg/dL, SBP <150 mm Hg, and DBP <90 mm Hg.

Most of the patients met certain stringent ADA targets: 72% for HbA1C, 63% for LDL cholesterol, and 73% for blood pressure, but only about one-third met all 3 targets. Using less stringent measures, the patients met 90%, 86%, and 87% of the individual targets, respectively, and 68% met all 3 targets.

The researchers also found that white patients tended to meet the treatment targets more often than their African-American counterparts. In fact, African-American women were less likely than white women to meet all 3 targets simultaneously and to meet blood pressure targets in particular. In addition, this disparity could not be fully attributed to demographic or clinical characteristics, the authors found.

“Our findings extend those from previous studies that have reported racial and socioeconomic disparities in risk factor control in people with diabetes,” they concluded.

Overall, those who were most likely to meet the targets were white males with a higher income, greater physical function, and shorter disease duration.

Patients who had diabetes for at least 15 years were less likely to meet HbA1C and blood pressure targets than those with the condition for a shorter period of time.

The researchers noted that the American Geriatrics Society recommends different treatment targets based on age or comorbidity status.

“Many older adults may not reap the full benefits of tight risk factor control, particularly glycemic control, and may be overtreated,” they posited.

With this consideration, there has been increased interest in individualized treatment targets, though the researchers noted that it is unclear how to find the right targets for individuals that would maximize health benefits and minimize adverse outcomes.

“There is tremendous debate about appropriate clinical targets for diabetes in older adults, particularly for glucose control,” study author Elizabeth Selvin, PhD, MPH, said in a press release. “Are some older adults being over-treated? Are some being undertreated? These are questions for which we don't have answers.”

These findings were published in Diabetes Care.