Tight glycemic control plus overmedication may increase hospitalizations
SAN DIEGO — Older adults with diabetes who maintain tight glycemic control and who use two or more types of glucose-lowering medications have an increased risk hospitalization and longer length of hospital stay compared with patients who maintain moderate control and use fewer medications, according to data presented here.
“Guidelines acknowledge the need to individualize glycemic control among older adults,” Jennifer L. Kuntz, PhD, assistant investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon, said during a presentation. “However, it is rather unclear how to accomplish this, considering that a lot of older adults have many risk factors including multiple comorbidities, cognitive decline and polypharmacy. The characterization of utilization outcomes based on the use of treatments and treatment outcomes including glycemic control may serve as a step toward individualizing treatment.”
Kuntz and colleagues evaluated 10,091 patients with diabetes (mean age, 75 years; mean HbA1c, 7.2%; years since diagnosis, 9.6 years) at Kaiser Permanente Northwest to determine whether health care utilization varies with glucose-lowering medication use and HbA1c levels.
Glycemic control was evaluated using mean HbA1c levels and use of glucose-lowering medication classes including insulin, secretagogues, metformin and others. Health care utilization was measured based on hospitalization and number of emergency room and outpatient visits from Oct. 1, 2014, to Sept. 30, 2015. Mean HbA1c was classified as tight (< 7%; n = 5,065), moderate (7% to 8.9%; n = 4,386) or poor ( 9%; n = 640) glycemic control. Participants were categorized by level of glycemic control and use of glucose-lowering medication classes (< 2 vs. 2).
Among participants with tight glycemic control, 84% received fewer than two glucose-lowering medication classes. Two or more glucose-lowering medication classes were used by 51% of participants with moderate glycemic control and 70% with poor control.
Participants with tight glycemic control who received at least two glucose-lowering medication classes had 24% more mean hospitalizations compared with participants with tight control who received fewer than two glucose-lowering medication classes (P = .0008) and 55% more mean hospitalizations than participants with moderate control who received fewer than two glucose-lowering medication classes (P < .001). Similarly, participants with tight control who received at least two glucose-lowering medication classes had 37% more mean hospital days compared with participants with tight control who received fewer than two glucose-lowering medication classes (P = .008) and 63% more mean hospital days than participants with moderate control who received fewer than two glucose-lowering medication classes (P < .001).
There were no significant differences between groups for ED visits or outpatient visits.
“Tight glycemic control achieved with multiple [glucose-lowering medications] is associated with greater hospital utilization compared with tight and moderate control using fewer [glucose-lowering medications],” Kuntz said. “Our results suggest that overtreatment, tight [glycemic] control and more medications may be hazardous for elderly patients and also may generate unnecessary health care utilization of our health care systems.” – by Amber Cox
Kuntz JL, et al. 301-OR. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.
Disclosures: Kuntz reports financial ties with Merck and Pfizer.