This analysis demonstrated that elderly population with type 2 diabetes mellitus (T2DM) visiting Primary Health Care (PHC) units had a satisfactory glycemic control with the combined use of oral anti-diabetic drugs and insulin.




Main Takeaway

  • Oral anti-diabetic drugs plus insulin showed better glycemic control in elderly population with T2DM.
  • In addition, about 75% of the elderly people had acceptable glycemic control.
  • Negative associations were noted between glycemic control (poor) and other variables, such as cardiovascular disease, amputation of lower extremities, and ulcer.

Why This Matters

  • PHC units play a vital role in managing T2DM via collective and individual interventions.
  • In aging population, health conditions and variables affecting the care of non-communicable chronic diseases should be assessed.
  • The present study aimed to evaluate the glycemic control of elderly T2DM people attending PHCs.

Study Design

This cross-sectional study included elderly people with T2DM registered at the local family healthcare units in Ribeirão Preto, São Paulo, Brazil, and assessed data on adhesion to treatment.

  • The study was conducted from March to October 2018 via household interviews and by assessing laboratory tests in past 6 months.

 

Inclusion criteria: 

People aged ≥60 years; clinical diagnosis of T2DM regardless of time; continuous use of medication for T2DM treatment; registered in the family health system selected and non-institutionalized.

 

Exclusion criteria: 

Participants without results of laboratory tests conducted in past 6 months.

 

Dependent variable: 

Glycemic control (assessed by measuring glycated hemoglobin [HbA1c ≤8.0% (64 mmol/mol)] and fasting glucose test [≤150 mg/dL])

 

Independent variables: 

Gender, age group, self-reported skin color, education level, time since T2DM diagnosis

Key Results

In total, 243 elderly people with T2DM participated in the study (women: 67.1%; mean age: 70.3 ± 7.7 years)

 

Dependent variables:

  • The Kappa concordance for glycemic control between HbA1c and fasting glucose test results was 0.52 (95% confidence interval [CI]: 0.40–0.65).
  • Mean HbA1c was 7.2% (standard deviation [SD] = 1.7).
  • Overall, 74.1% (95% CI: 68.5–79.5) elderly people had HbA1c <8%.

 

Independent variables:

  • The predominant self-reported skin color was white (58.4%).
  • Most participants (74.9%) had a low education level,i.e., up to 4 years of schooling.
  • Overall, >80% participants did not report alcohol or tobacco abuse; 60.9% reported having good or very good health.
  • On average, 3.1 diseases (SD = 1.8) were associated with T2DM, with the most common diseases being systemic arterial hypertension (82.5%), dyslipidemia (57.7%), and overweight/obesity (24.6%).
  • In total, 4.9% reported the presence of ulcer and 3.7% reported amputation of lower extremities.
  • A majority of participants (87.3%) had T2DM for >5 years.
  • Overall, 72.8%, 5.8%, and 21.4% of elderly people used oral anti-diabetic drugs only, insulin only, and a combination of oral anti-diabetic drug and insulin, respectively.

Glycemic control was positively associated with the use of oral anti-diabetic drugs plus insulin (adjusted prevalence ratio [PR] = 1.18, 95% CI: 1.07−1.32, P <0.001).

 

However, glycemic control was negatively associated with the following:

  • Cardiovascular disease: Adjusted PR = 0.79, 95% CI: 0.74−0.85, P <0.001.
  • Ulcer: Adjusted PR = 0.81, 95% CI: 0.75−0.87, P<0.001
  • Amputation of lower extremities: Adjusted PR = 0.80,95% CI: 0.75−0.87, P <0.001

Limitations

  • The model proposed does not allow the establishment of causal correlations between the variations
  • Reference values of HbA1c and fasting glycemia could not be determined owing to uncertainties regarding the ideal glycemic index for older adults with T2DM.
    Oliveira REM, Franco LJ. Glycemic control in elderly people with type 2 diabetes mellitus attending primary healthcare units. Prim Care Diabetes. 2021. doi: 10.1016/j.pcd.2021.04.011. Epub ahead of print. PMID: 33903088.

MAT-BH-2100788/v1/Oct 2021