Tight glycaemic control associated with mortality in older people

Bruce DG, Davis WA, Davis TME (2018) Glycaemic control and mortality in older people with type 2 diabetes: The Fremantle Diabetes Study Phase II. Diabetes Obes Metab  20: 2852–9 

• The Freemantle Diabetes Study Phase II investigated whether using pharmacotherapy to achieve tight glycaemic control in older people (aged ≥75) with diabetes increased all-cause mortality.
• Between 2008 and 2011, 367 participants were recruited and followed for a median of 6.7 years to assess the impact of baseline HbA1c on their risk of mortality.
• At baseline, 60.4% of participants were on regimens including metformin, 35.3% were receiving a sulphonylurea as part of their diabetes management, and 23.2% were taking insulin.
• During the study period, 40.9% of participants died and, compared to non-pharmacological treatment, baseline HbA1c was found to be significantly associated with mortality.
• Mortality was increased in older people on metformin with HbA1c <48 mmol/mol (<6.5%) and in those taking sulphonylureas and insulin with HbA1c levels <52 mmol/mol (<7.0%).
• Researchers concluded that overtreatment leads to clinical problems in older people with type 2 diabetes and that tight glycaemic control with pharmacotherapy may be hazardous in this patient group.

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