Glucose Control, Sulfonylureas, and Insulin Treatment in Elderly People With Type 2 Diabetes and Risk of Severe Hypoglycemia and Death: An Observational Study

Objective: To estimate the relative and absolute risk of severe hypoglycemia and mortality associated with glucose control, sulphonylurea and insulin treatment in elderly people with type 2 diabetes. Research Design and Methods: We identified elderly subjects (≥70 years) with type 2 diabetes between 2000 and 2017 in the UK CPRD primary care database with linkage to hospitalization and death data. Subjects with three consecutive HbA1c <7% (53 mmol/mol) while on insulin and/or sulphonylurea within 60 days prior to the third HbA1c (exposed) were matched to not exposed. Hazard ratios (HRs) and absolute risks were estimated for hospitalizations for severe hypoglycemia and cardiovascular and non-cardiovascular-related mortality. Results: Among 22,857 included subjects (6288 [27.5%] exposed, of which 5659 [90.0%] on sulphonylurea), 10,878 (47.6%) deaths and 1392 (6.1%) severe hypoglycemic episodes occurred during the follow-up. Compared to non-exposed, the adjusted HR in exposed was 2.52 (95% CI: 2.23, 2.84) for severe hypoglycemia; 0.98 (0.91, 1.06) for cardiovascular mortality; and 1.05 (0.99, 1.11) for non-cardiovascular mortality. In a 70-, 75-, 80- and 85-year-old subject, the 10-year risk of severe hypoglycemia was 7.7%, 8.1%, 8.6%, and 8.4% higher than non-exposed while differences for non-cardiovascular mortality ranged from 1.2% (-0.1, 2.5) in a 70-year-old to 1.6% (-0.2, 3.4) in an 85-year-old subject. Sulphonylurea and insulin were more relevant predictors of severe hypoglycemia and death than glucose levels. Conclusions: Elderly subjects with type 2 diabetes and low HbA1c on sulphonylurea or insulin treatment experienced a substantially higher risk of hospitalization for severe hypoglycemia but had no clear evidence of increased risks of mortality.

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Glucose Control, Sulfonylureas, and Insulin Treatment in Elderly People With Type 2 Diabetes and Risk of Severe Hypoglycemia and Death: An Observational Study

10.2337/figshare.13568543.v1 ◽

2021 ◽

Author(s):

Suping Ling ◽

Francesco Zaccardi ◽

Claire Lawson ◽

Samuel I Seidu ◽

Melanie J Davies ◽

...

Keyword(s):

Type 2 Diabetes ◽

Elderly People ◽

Cardiovascular Mortality ◽

Glucose Control ◽

Insulin Treatment ◽

Absolute Risk ◽

Severe Hypoglycemia ◽

Elderly Subjects ◽

Glucose Levels

Objective: To estimate the relative and absolute risk of severe hypoglycemia and mortality associated with glucose control, sulphonylurea and insulin treatment in elderly people with type 2 diabetes. Research Design and Methods: We identified elderly subjects (≥70 years) with type 2 diabetes between 2000 and 2017 in the UK CPRD primary care database with linkage to hospitalization and death data. Subjects with three consecutive HbA1c <7% (53 mmol/mol) while on insulin and/or sulphonylurea within 60 days prior to the third HbA1c (exposed) were matched to not exposed. Hazard ratios (HRs) and absolute risks were estimated for hospitalizations for severe hypoglycemia and cardiovascular and non-cardiovascular-related mortality. Results: Among 22,857 included subjects (6288 [27.5%] exposed, of which 5659 [90.0%] on sulphonylurea), 10,878 (47.6%) deaths and 1392 (6.1%) severe hypoglycemic episodes occurred during the follow-up. Compared to non-exposed, the adjusted HR in exposed was 2.52 (95% CI: 2.23, 2.84) for severe hypoglycemia; 0.98 (0.91, 1.06) for cardiovascular mortality; and 1.05 (0.99, 1.11) for non-cardiovascular mortality. In a 70-, 75-, 80- and 85-year-old subject, the 10-year risk of severe hypoglycemia was 7.7%, 8.1%, 8.6%, and 8.4% higher than non-exposed while differences for non-cardiovascular mortality ranged from 1.2% (-0.1, 2.5) in a 70-year-old to 1.6% (-0.2, 3.4) in an 85-year-old subject. Sulphonylurea and insulin were more relevant predictors of severe hypoglycemia and death than glucose levels. Conclusions: Elderly subjects with type 2 diabetes and low HbA1c on sulphonylurea or insulin treatment experienced a substantially higher risk of hospitalization for severe hypoglycemia but had no clear evidence of increased risks of mortality.

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Effects of Glucose Control on Hematological Indices in Patients with Diabetes Mellitus

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2014.015 ◽

2014 ◽

Vol 2 (1) ◽

pp. 83-88

Author(s):

Ceyhun Varım ◽

Tezcan Kaya ◽

Ahmet Nalbant ◽

Ayşenur Uçar ◽

Ali Tamer

Keyword(s):

Type 2 Diabetes ◽

Insulin Therapy ◽

Glucose Control ◽

Insulin Treatment ◽

Treatment Modalities ◽

Hematological Indices ◽

Blood Indices ◽

Insulin Group ◽

Patients With Diabetes

Aim: We aimed to investigate the effects of diabetes treatment modalities on haematological parameters and leukocyte formula in patients with type 2 diabetes mellitus.Materials and Methods: The study included 102 patients with type 2 diabetes, out of which 51 receiving insulin treatment and 51 receiving oral antidiabetics (OAD). Hemogram data of insulin and OAD treated groups were compared.Results HbA1c levels were 11.12 ± 2.09 mg/dl in insulin group and 7.94 ± 2.1 mg/dl in OAD group p=0.001. Platelet counts were 27866.67 ± 77693 109/L before treatment and 258941.18 ± 69068.2 109/L in OAD group at six months, p: 0.015 whereas; 293011.76 ± 73711.21 109/L before treatment and 289492.86 ± 82631.49 109/L in insulin group at six months p: 0.821. Monocyte counts were 0.47 ± 0.12 109/L before the treatment and 0.57 ± 0.12 109/L in mix insulin therapy subgroup at six months, p:0.004; monocyte percentage was % 6.11 ± 1.74 before the treatment and %7.51 ± 2.57 in mix insulin subgroup at six months p:0.039; Basophiles counts were 0.1 ± 0.02 109/L before treatment and 0.09 ± 0.04 109/L in intensive insulin therapy subgroup at six months, p: 0.005; Lymphocyte and basophils counts were significantly decreased at six months insulin treatment as compared to the pretreatment values.Conclusion: This study showed that, glucose control effects; blood indices HbA1C, basophiles, eosinophils, platelets and lymphocytes counts.

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Glimepiride monotherapy in achieving good blood glucose control in type-2 diabetes mellitus: a prospective observational study

Medical Journal of Indonesia ◽

10.13181/mji.v18i3.357 ◽

2009 ◽

pp. 172

Author(s):

Kris Pranarka ◽

Arini Setiawati ◽

Samsirun Halim ◽

Dian Saraswati ◽

Zulkifli Alkaf

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Blood Glucose ◽

Observational Study ◽

Glucose Control ◽

Prospective Observational Study ◽

Blood Glucose Control

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Ten years of NovoMix 30 in Russian and international clinical practice

Diabetes Mellitus ◽

10.14341/dm20134101-107 ◽

2013 ◽

Vol 16 (4) ◽

pp. 101-107

Author(s):

Elena Viktorovna Surkova

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Clinical Practice ◽

Elderly People ◽

Insulin Treatment ◽

Therapeutic Goals ◽

Biphasic Insulin

Insulin treatment for type 2 diabetes mellitus is challenging in elderly people. Biphasic insulin preparations technically simplify this task, but also increase compliance and facilitate the achievement of therapeutic goals.

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Short-term impact of COVID-19 lockdown on metabolic control of patients with well-controlled type 2 diabetes: a single-centre observational study

Acta Diabetologica ◽

10.1007/s00592-020-01637-y ◽

2020 ◽

Author(s):

Edoardo Biancalana ◽

Federico Parolini ◽

Alessandro Mengozzi ◽

Anna Solini

Keyword(s):

Type 2 Diabetes ◽

Observational Study ◽

Metabolic Control ◽

Glucose Control ◽

Single Centre ◽

Short Term ◽

Serum Triglycerides ◽

The Mean ◽

Persistent Elevation

Abstract Aims/hypothesis The strict rules applied in Italy during the recent COVID-19 pandemic, with the prohibition to attend any regular outdoor activity, are likely to influence the degree of metabolic control in patients with type 2 diabetes. We explored such putative effect immediately after the resolution of lockdown rules, in the absence of any variation of pharmacologic treatment. Methods One-hundred and fourteen patients with adequate metabolic control took part in this single-centre, prospective, observational study. The metabolic profile tested 1 week after the end of the lockdown was compared with the last value and the mean of the last three determinations performed before the pandemic emergency (from 6 months to 2 years before). Results After 8 weeks of lockdown, an increase of HbA1c > 0.3% (mean +0.7%) was observed in 26% of the participants; these were also characterized by a persistent elevation in serum triglycerides able to predict the worsening of glucose control. Conclusions Lockdown determined a relevant short-term metabolic worsening in approximately one-fourth of previously well-controlled type 2 diabetic individuals; pre-lockdown triglycerides were the only parameter able to predict such derangement of glucose control.

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