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Trends in HbA1c thresholds for initiation of hypoglycemic agents: Impact of changed recommendations for older and frail patients

21 September 2020

​Martina Ambrož, Sieta T. de Vries, Klaas Hoogenberg, Petra Denig

Treatment of blood glucose in older and frail patients with type 2 diabetes in the same way as in younger and fit patients can result in different adverse reactions. Therefore, less strict glucose targets have been recommended by the guidelines in older and less fit patients in the last decade. To see how these recommendations are implemented in the clinical practice, we looked at the initiation of glucose lowering medication between the years 2008 and 2014. We found that patients aged 60 to 79 years initiated glucose lowering treatment earlier than older and younger patients, with no differences between fit and frail patients. This means that younger patients are treated too late and that frail patients are treated too much. In addition, we also saw that patients after 2012 started with glucose lowering treatment later, which is not in line with the guidelines. The decision when to initiate glucose lowering treatment in clinical practice should be more aligned with the patients' age and health state.  

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