Abstract
Aims In older adults with type 2 diabetes (T2D), overtreatment remains
prevalent and undertreatment ignored. The main objective is to estimate
the prevalence and examine factors associated with potential
overtreatment and undertreatment Method Observational study conducted
within an administrative database of older adults with T2D who
registered in 2018 at the Portuguese Diabetes Association. Participants
were categorized either as potentially overtreated (HbA1c≤7.5%),
appropriately on target (HbA1c≥7.5–≤9%), or potentially undertreated
(HbA1c>9%). Results of 444 participants, potential
overtreatment, and undertreatment were found in 60.5% and 12.6% of the
study population. Taking the patients on target as a comparator, the
group of potentially overtreated showed to be more males (61.3%
vs.52.2%), less-obese (34.1% vs.39.2), higher cardiovascular diseases
(13.7% vs.11%), peripheral vascular diseases (16.7% vs.12.8%),
diabetic foot (10% vs.4.5%), and severe kidney disease (5.2%
vs.4.5%). Conversely, the potentially undertreated participants were
more females (64.2% vs.47.7%), obese (49% vs.39.2%), had more
dyslipidemia (69% vs.63.1%), peripheral vascular disease (14.2%
vs.12.8%), diabetic foot (8.9% vs.4.5%), and infections (14.2%
vs.11.9%). The odds of potential overtreatment were mostly decreased by
59% of females, 73.5% in those with retinopathy, and 86.3% in
insulin, 65.4% sulfonylureas, and 66.8% in SGLT2 inhibitors users.
Contrariwise, an increase in the odds of potential undertreatment was
more than 4.8times higher in insulin, and more than 3.1times higher in
sulfonylureas users. Conclusion potential overtreatment and
undertreatment in older adults with T2D in routine clinical practice
should guide the clinicians to balance the use of newer oral
antidiabetic agents considering its safety profile regarding
hypoglycemia.