Diabetes Overtreatment and Hypoglycemia in Older Patients With Type 2 Diabetes on Insulin Therapy: Insights From the HYPOAGE Cohort Study

OBJECTIVE To assess the accuracy of “diabetes overtreatment” proxy definitions in predicting hypoglycemia in older adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Inclusion of patients from HYPOAGE cohort with insulin-treated T2D, aged ≥75 years, and using a continuous glycemic monitoring (CGM) device for 28 days. “Diabetes overtreatment” was defined as HbA1c < 7.0% (fixed proxy definition) or as HbA1c < 7.0%, 7.5% and 8.0% according to patient’s health status (individualized proxy definition). The primary outcome was time below range (TBR) ≥ 1%. RESULTS Of the 134 patients included (81.6 ± 5.4 years, 59% male), 25 (19%) and 53 (40%) were overtreated, based on fixed and individualized proxy definitions, respectively. CGM data showed TBR >1% in nearly all patients regardless of overtreatment status. Both proxy definitions had low sensitivity (20% [14%; 29%] and 41% [32%; 50%]) and accuracy (27% [20%; 35%] and 44% [35%; 53%]) in predicting hypoglycemia. CONCLUSIONS A revised definition of diabetes overtreatment is needed to better manage older insulin-treated patients and protect them from hypoglycemia.