title: Is there evidence of potential overtreatment of glycaemia in elderly people with type 2 diabetes? Data from the GUIDANCE study.
abstract: OBJECTIVE
  We used data from the GUIDANCE Study to determine the care of people with type 2 diabetes according to age and accompanying cardiovascular diseases and to assess indicators of overtreatment of glycaemia.
  
  
  METHODS
  The GUIDANCE study was a retrospective, cross-sectional study from 2009-2010 based on the records of 7597 people in France, Belgium, Italy, the Netherlands, Sweden, UK, Ireland and Germany. We analysed the level of metabolic control achieved and blood glucose-lowering medication used in different age groups and in relation to accompanying diseases.
  
  
  RESULTS
  4.459 patients (59.1%) were 65 years or older. Their HbA1c levels were similar to those with <65 years. 44.7% of patients ≥65 years had an HbA1c ≤7% (53 mmol/mol) and were treated with insulin or sulfonylureas, and 27.1% of them had ischaemic heart disease or congestive heart failure. Significantly more patients with heart disease had HbA1c values ≤7% (53 mmol/mol) and were treated more often with insulin or sulfonylureas compared to patients of the same age without heart disease.
  
  
  CONCLUSIONS
  Most patients were treated according to guidelines valid at the time this large international patient sample was surveyed. Older and younger patients were at a similar level of metabolic control, and almost half of the patients with an age of ≥65 years and treated with insulin or sulfonylurea had HbA1c levels below the target range (≤7%) for younger patients. However, these patients have an increased risk of severe hypoglycaemic events with potentially dangerous complications, particularly in those with cardiovascular diseases.
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany. nicolle.mueller@med.uni-jena.de.
authors.forename: Nicolle
authors.identifier: http://orcid.org/0000-0002-0303-7322
authors.initials: N
authors.lastname: Müller
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.|German Center for Diabetes Research (DZD), 85764, München-Neuherberg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Kuss
authors.affiliation: Department of Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Lindblad
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: John J
authors.initials: JJ
authors.lastname: Nolan
authors.affiliation: Department of General Practice, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Guy Ehm
authors.initials: GE
authors.lastname: Rutten
authors.affiliation: Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Trento
authors.affiliation: Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Porta
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Roth
authors.affiliation: Corbeil-Essonnes Hospital, Corbeil-Essonnes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Charpentier
authors.affiliation: EASD 1988-2015, Düsseldorf, Germany.
authors.forename: Viktor
authors.initials: V
authors.lastname: Jörgens
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany.
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Müller
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D013453:Sulfonylurea Compounds / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds
keywords: HbA1c; Hypoglycaemia; Overtreatment; Type 2 diabetes