title: Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Cross-sectional study: data from 980 diabetic patients ≥75 years with renal disease are presented.
  
  
  RESULTS
  Patients had a mean age of 81 years (range 75-101) with long-standing diabetes (15.4 years) often complicated (half with macrovascular disease). Mean estimated glomerular filtration rate was 43 mL/min/1.73 m(2) and 20% had severe RI. Mean hemoglobin A1c was 7.4%. Anti-diabetic therapy was oral based for 51% of patients (60% ≥2 oral anti-diabetic drugs [OAD]) and insulin based for 49% (combined with OAD in 59%). OAD included metformin (47%), sulfonylureas (26%), glinides (19%), and DPP-4 inhibitors (31%). Treatments were adjusted to increasing RI, with less use of metformin, sulfonylureas, and DPP-4 inhibitors, and more glinides and insulin in severe RI. In all, 579 (60%) of these elderly patients with comorbidities had hemoglobin A1c <7.5% (mean 6.7%) while being intensively treated: 69% under insulin-secretagogues and/or insulin, putting them at high risk for severe hypoglycemia. Only one-fourth were under oral monotherapy.
  
  
  CONCLUSIONS
  In clinical practice, a substantial proportion of elderly patients may be overtreated. RI is insufficiently taken into account when prescribing OAD.
authors.affiliation: Department of Endocrinology and Diabetology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes Cedex, France.
authors.forename: Alfred
authors.initials: A
authors.lastname: Penfornis
authors.affiliation: Clinical Affairs, Novartis Pharma SAS, Rueil-Malmaison, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Fiquet
authors.affiliation: Department of Internal Medicine and Diabetology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Jean Frédéric
authors.initials: JF
authors.lastname: Blicklé
authors.affiliation: Clinical Affairs, Novartis Pharma SAS, Rueil-Malmaison, France ; Department of Diabetology, Metabolism and Endocrinology, Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Dejager
keywords: elderly; hypoglycemia; overtreatment; renal impairment; sulfonylureas; type 2 diabetes mellitus