Tight Glycemic Control and Use of Hypoglycemic Medications in Older Veterans With Type 2 Diabetes and Comorbid Dementia

• DOI: 10.2337/dc14-0599
• Publication Date: 2015-01-16T02:35:00Z
• Authors: Carolyn T. Thorpe; Walid F. Gellad; Chester B. Good; Sijian Zhang; Xinhua Zhao; Maria Mor; Michael J. Fine
• Keywords: Veterans Affairs

OBJECTIVE Older adults with diabetes and dementia are at increased risk for hypoglycemia other adverse events associated tight glycemic control unlikely to experience long-term benefits. We examined factors in this population use of medications a high the subset control. RESEARCH DESIGN AND METHODS This retrospective cohort study national Veterans Affairs (VA) administrative/clinical data Medicare claims fiscal years (FYs) 2008–2009 included 15,880 veterans aged ≥65 type 2 prescribed antidiabetic medication. Multivariable regression analyses were used identify sociodemographic clinical predictors hemoglobin A1c (HbA1c) (tight, moderate, poor, or not monitored) and, patients control, subsequent medication (sulfonylureas, insulin). RESULTS Fifty-two percent had (HbA1c <7% [53 mmol/mol]). Specific comorbidities, older age, recent weight loss greater odds versus moderate whereas Hispanic ethnicity obesity lower Among tightly controlled patients, 75% sulfonylureas and/or insulin, higher who male, black, ≥75 years; hospital nursing home stay FY2008; congestive heart failure, renal peripheral vascular disease. CONCLUSIONS Many intense treatment may be candidates deintensification alteration medications.