Relationship between achieved personalized glycaemic targets and monitoring of clinical events in elderly diabetic patients.
OBJECTIVE
Recent guidelines for the management of type 2 diabetes (T2DM) in the elderly recommend adjusting the therapeutic target (HbA1c) according to the patient's health. Our study aimed to explore the association between achieving the recommended personalized HbA1ctarget and the occurrence of major clinical events under real-life conditions.


METHODS
The T2DM S.AGES cohort was a prospective multicentre study into which 213 general practitioners recruited 983 non-institutionalized T2DM patients aged>65 years. The recommended personalized HbA1ctargets were<7%, <8% and <9% for healthy, ill and very ill patients, respectively. Major clinical events (death from any cause, major vascular events and/or hospitalization) were recorded during the 3-year follow-up. Mixed-effects logistic regression models were used for the analyses.


RESULTS
Of the 747 patients analyzed at baseline, 551 (76.8%) were at their recommended personalized HbA1ctarget. During follow-up, 391 patients (52.3%) experienced a major clinical event. Of the patients who did not achieve their personalized HbA1ctarget (compared with those who did), the risk (OR) of a major clinical event was 0.95 (95% CI: 0.69-1.31; P=0.76). The risk of death, major vascular event and hospitalization were 0.88 (95% CI: 0.40-1.94; P=0.75), 1.14 (95% CI: 0.7-1.83; P=0.59) and 0.84 (95% CI: 0.60-1.18; P=0.32), respectively.


CONCLUSIONS
Over a 3-year follow-up period, our results showed no difference in risk of a major clinical event among patients, regardless of whether or not they achieved their personalized recommended HbA1ctarget. These results need to be confirmed before implementing a more permissive strategy for treating T2DM in elderly patients.
CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 94275 Kremlin-Bicêtre, France; General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, 63, rue Gabriel-Peri, 94275 Le Kremlin-Bicêtre, France. Electronic address: sophie.bucher@u-psud.fr.
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S
Bucher
CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 94275 Kremlin-Bicêtre, France.
H
H
Panjo
Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-virology, IDMIT, Inserm Center for immunology of viral infections and autoimmune diseases, Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
A
A
Al-Salameh
Endocrinology department, Begin hospital, Saint-Mandé, France.
B
B
Bauduceau
Medical Director of ORPEA/CLINEA, Puteaux, France.
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L
Benattar-Zibi
Rheumatology Department, Limoges University Hospital, Limoges, France.
P
P
Bertin
Clinical Gerontology, Nantes University Hospital, Nantes, France.
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G
Berrut
Inserm U 1178, Paris-Sud Faculty of Medicine, University of Paris-Sud, Psychiatry Department, Bicêtre University Hospital, Assistance publique-Hôpitaux de Paris, Le Kremlin- Bicêtre, France.
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E
Corruble
HEGP, Coronary Diseases, Paris, France.
N
N
Danchin
Cardiovascular Functional Exploration, Louis-Pradel Hospital, Hospices Civils de Lyon, Bron, France.
G
G
Derumeaux
Internal medicine, Geriatry and therapeutics, Saint-Julien university Hospital, Rouen University, Rouen, France.
J
J
Doucet
CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 94800 Villejuif, France.
B
B
Falissard
University of Paris Descartes, National Foundation of Gerontology, Paris, France.
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F
Forette
University of Paris Descartes, EA 4468, Assistance publique-Hôpitaux de Paris, Broca Hospital, Geriatrics Department, Paris, France.
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O
Hanon
General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, 63, rue Gabriel-Peri, 94275 Le Kremlin-Bicêtre, France.
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R
Ourabah
University of Lille Nord de France, UDSL, EA 1046, CHU de Lille, Lille, France.
F
F
Pasquier
Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-virology, IDMIT, Inserm Center for immunology of viral infections and autoimmune diseases, Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
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C
Piedvache
Endocrinology, Diabetes and Nutrition-Related Diseases (NUDE Unit), Strasbourg University Hospital and the European Centre for the Study of Diabetes (CeeD), University of Strasbourg, Strasbourg, France.
M
M
Pinget
Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-virology, IDMIT, Inserm Center for immunology of viral infections and autoimmune diseases, Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
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L
Becquemont
CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 94275 Kremlin-Bicêtre, France.
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V
Ringa
D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
Cohort; Diabetes; Elderly; Major vascular event; Therapeutic target