Bruce DG, et al. - In older people with type 2 diabetes, researchers examined whether all-cause mortality is increased with tight glycemic control attained with metformin, insulin or sulphonylurea-based pharmacotherapy. Particularly with insulin or sulphonylureas, but metformin as well, tight glycemic control might be hazardous in older people with type 2 diabetes when achieved with pharmacotherapy. In this vulnerable population, overtreatment may be an essential clinical issue.

Methods

• For this prospective cohort study, people with known diabetes were enrolled between 2008 and 2011, and followed until 2016.
• In those aged ≥75 years, the effect of baseline glycated hemoglobin (HbA1c) on mortality hazards was examined.
• Proportional hazards models for time to death were constructed from the baseline clinical assessment, then the variables of interest (HbA1c, treatment category and their interactions) were entered.

Results

• According to the findings, 367 members (mean age 80.1±3.9 years, median HbA1c 6.7 [interquartile range: 6.3-7.3]%, 50 [45-56] mmol/mol) were followed for a median 6.7 (4.5-7.7) years, during which 40.9% died.
• Researchers found that 60.4% were on metformin-based treatment, 35.3% on sulphonylurea-based treatment and 23.2% on treatment including insulin, at baseline.
• Compared with non-pharmacological treatment, baseline HbA1c was significantly correlated with mortality in a model that included interactions between HbA1c and the three treatment-based groups.
• Findings revealed that the metformin treatment group had increased mortality when HbA1c <6.5% (<48 mmol/mol), and the sulphonylurea and insulin treatment groups had increased mortality when HbA1c <7.0% (52 mmol/mol) with hazard ratios (95% CI) of 2.63 (1.39-4.97); 2.49 (1.14-5.44) and 2.22 (1.12-4.43) respectively.