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Tight glycaemic control associated with mortality in older people

Care of Older People – November digest. A summary of phase II of the Freemantle Diabetes Study looking at the association between glycaemic control and mortality. 

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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