Decline in use of high-risk agents for tight glucose control among older adults with diabetes in New York City: 2017–2022

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-07-09 DOI:10.1111/jgs.19060

Jeff Zhang MS, Rania Kanchi MPH, Sarah Conderino DrPH, MPH, Natalie K. Levy MD, Samrachana Adhikari PHD, Saul Blecker MD, Nichola Davis MD, Jasmin Divers PHD, Catherine Rabin BS, Mark Weiner MD, Lorna Thorpe PhD, MPH, John A. Dodson MD, MPH

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Abstract

Background

This study aimed to examine the prevalence of inappropriate tight glycemic control in older adults with type 2 diabetes and other chronic conditions in New York City, and to identify factors associated with this practice.

Methods

We conducted a retrospective cohort study using the INSIGHT Clinical Research Network. The study population included 11,728 and 15,196 older adults in New York City (age ≥ 75 years) with a diagnosis of type 2 diabetes, and at least one other chronic medical condition, in 2017 and 2022, respectively. The main outcome of interest was inappropriate tight glycemic control, defined as HbA1c <7.0% (<53 mmol/mol) with prescription of at least one high-risk agent (insulin or insulin secretagogue).

Results

The proportion of older adults with inappropriate tight glycemic control decreased by nearly 19% over a five-year period (19.4% in 2017 to 15.8% in 2022). There was a significant decrease in insulin (27.8% in 2017; 24.3% in 2022) and sulfonylurea (29.4% in 2017; 21.7% in 2022) medication prescription, and increase in use of GLP-1 agonists (1.8% in 2017; 11.4% in 2022) and SGLT-2 inhibitors (5.8% in 2017; 25.1% in 2022), among the total population. Factors associated with inappropriate tight glycemic control in 2022 included history of heart failure (adjusted odds ratio [aOR] 1.38), chronic kidney disease ([aOR] 1.93), colorectal cancer ([aOR] 1.38), acute myocardial infarction ([aOR] 1.28), “other” ([aOR] 0.72) or “unknown” ([aOR] 0.72) race, and a point increase in BMI ([aOR] 0.98).

Conclusions

We found an encouraging trend toward less use of high-risk medication strategies for older adults with type 2 diabetes and multiple chronic conditions. However, one in six patients in 2022 still had inappropriate tight glycemic control, indicating a need for continued efforts to optimize diabetes management in this population.

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纽约市老年糖尿病患者为严格控制血糖而使用高风险药物的减少情况：2017-2022 年。

背景：本研究旨在调查纽约市患有 2 型糖尿病和其他慢性疾病的老年人中血糖控制不当的普遍程度，并确定与这种做法相关的因素：本研究旨在调查纽约市患有 2 型糖尿病和其他慢性疾病的老年人中血糖控制不当的普遍程度，并确定与这种做法相关的因素：我们利用 INSIGHT 临床研究网络开展了一项回顾性队列研究。研究人群包括纽约市 2017 年和 2022 年分别确诊为 2 型糖尿病和至少一种其他慢性疾病的 11728 名和 15196 名老年人（年龄≥ 75 岁）。主要研究结果是不适当的严格血糖控制，定义为 HbA1c 结果：血糖控制不当的老年人比例在五年内下降了近19%（2017年为19.4%，2022年为15.8%）。在所有人群中，胰岛素（2017 年为 27.8%；2022 年为 24.3%）和磺脲类药物（2017 年为 29.4%；2022 年为 21.7%）的处方明显减少，而 GLP-1 激动剂（2017 年为 1.8%；2022 年为 11.4%）和 SGLT-2 抑制剂（2017 年为 5.8%；2022 年为 25.1%）的使用有所增加。与 2022 年不适当严格控制血糖相关的因素包括：心力衰竭病史（调整后比值比 [aOR] 1.38）、慢性肾病（[aOR] 1.93）、结直肠癌（[aOR] 1.38）、急性心肌梗死（[aOR] 1.28）、"其他"（[aOR] 0.72）或 "未知"（[aOR] 0.72）种族，以及体重指数增加一个点（[aOR] 0.98）：我们发现，患有 2 型糖尿病和多种慢性疾病的老年人减少使用高风险药物治疗策略的趋势令人鼓舞。然而，在2022年，每六名患者中仍有一人血糖控制不当，这表明需要继续努力优化这一人群的糖尿病管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.