Insights Into the Current Management of Older Adults With Type 2 Diabetes in the Ontario Primary Care Setting

• Published in: Canadian journal of diabetes 2018-02, Vol.42 (1), p.23-30
• Main Authors: Meneilly, Graydon S., Berard, Lori D., Cheng, Alice Y.Y., Lin, Peter J., MacCallum, Lori, Tsuyuki, Ross T., Yale, Jean-François, Nasseri, Nahal, Richard, Jean-François, Goldin, Lianne, Langer, Anatoly, Tan, Mary K., Leiter, Lawrence A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood Glucose - metabolism; Blood Pressure; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; diabète de type 2; Disease Management; Female; fragilité; frailty; Glycated Hemoglobin A - analysis; Humans; Hypoglycemic Agents - therapeutic use; Male; Middle Aged; older individuals; Ontario - epidemiology; personnes âgées; pharmacotherapy; pharmacothérapie; Practice Guidelines as Topic; primary care; Primary Health Care; soins primaires; type 2 diabetes
• ISSN: 1499-2671; 2352-3840
• DOI: 10.1016/j.jcjd.2017.03.003

The Goal Oriented controL of Diabetes in the Elderly populatioN (GOLDEN) Program assessed the management of older persons with type 2 diabetes in Canadian primary care. Data were extracted from the records of 833 consecutively identified persons 65 years of age or older who had type 2 diabetes and were taking 1 antihyperglycemic agent or more; they were managed by 64 physicians from 36 Ontario clinics. More than half (53%) had glycated hemoglobin (A1C) levels of 7.0% or lower, 41% had blood pressure levels below 130/80 mm Hg, and 73% had low-density lipoprotein levels of 2.0 mmol/L or lower; 19% met all 3 criteria. Over the past year, 11% had been assessed for frailty, 16% for cognitive dysfunction and 19% for depression; 88% were referred for eye checkups, and 83% had undergone foot examinations. One-tenth were taking 4 or more antihyperglycemic agents, 87% statins and 52% an angiotensin-converting enzyme inhibitor. More than half of those with high clinical complexity had A1C levels of 7.0% or lower; of these, one-third were taking a sulfonylurea, and one-fifth were taking insulin. In the patients with A1C levels of 7.0% or above and low clinical complexity, there was often no up-titration or initiation of additional antihyperglycemic agents. Older persons with type 2 diabetes often have multiple comorbidities. Unlike eye and foot examinations, there was less emphasis on evaluating for frailty, cognitive dysfunction and depression. The GOLDEN patients had generally well-controlled glycemic, blood pressure and cholesterol profiles, but whether these would be reflected in a “sicker” population is not known. Personalized strategies are necessary to avoid undertreatment of “healthy” older patients and overtreatment of the frail elderly. Le programme GOLDEN (Goal Oriented controL of Diabetes in the Elderly populatioN) évaluait la prise en charge des personnes âgées atteintes du diabète de type 2 en milieu de soins primaires au Canada. Les données ont été extraites des dossiers médicaux de 833 personnes âgées, désignées de manière consécutive, qui avaient 65 ans ou plus, et qui souffraient du diabète de type 2 pour lequel elles prenaient 1 antihyperglycémiant ou plus; 64 médecins de 36 cliniques de l'Ontario les ont pris en charge. Plus de la moitié (53 %) avaient des concentrations d'hémoglobine glyquée (A1c) de 7,0 % ou moins, 41 % avaient des valeurs de pression artérielle de 130/80 mm Hg ou moins et 73 % avaient des concentrations de lipoprotéines de basse