Clinical features and sulfonylurea usage among outpatients with diabetes aged ≥90 years in an urban diabetes clinic in Tokyo. Issue 12 (19th September 2022)

• Record Type: Journal Article
• Authors: Kobori, Toshiko; Onishi, Yukiko; Yoshida, Yoko; Tahara, Tazu; Kikuchi, Takako; Kubota, Tetsuya; Iwamoto, Masahiko; Hamano, Shoko; Kasuga, Masato
• Is Part Of: Journal of diabetes investigation. Volume 13:Issue 12(2022)
• Page Start: 2010
• Page End: 2017
• Publication Date: 2022-09-19
• Subjects: Elderly diabetes patient -- Nonagenarian -- Reverse clinical inertia -- Sulfonylurea; Diabetes -- Periodicals; Diabetes -- Research -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462005
• DOI: 10.1111/jdi.13901
• Languages: English
• ISSNs: 2040-1116

Abstract

ABSTRACT: Aims/Introduction: Aging of society is accelerating in many countries. The purpose of this study was to describe the clinical features and sulfonylurea usage among diabetes outpatients aged ≥90 years (nonagenarians). Materials and Methods: This study was a retrospective observational study. The study population consisted of 69 nonagenarian diabetes outpatients and 857 diabetes outpatients aged <90 years. Patients were classified into four groups: group 1, <65 years; group 2, 65–74 years; group 3, 75–89 years; and group 4, ≥90 years. The presence of hypoglycemic episodes was defined as having self‐reported symptoms, or self‐monitored or clinically measured blood glucose level <70 mg/dL. Results: The median glycated hemoglobin (HbA1c) in group 1 and group 4 was 7.0% and 7.2%, respectively ( P = 0.506). The proportion of sulfonylurea treatment in group 4 was 45.5%, which is significantly higher compared with the other three groups (20.0–27.8%, P < 0.001). In group 4, there was no difference between patients with or without sulfonylurea in age, sex, body mass index, HbA1c and number of antihyperglycemic agents. Five out of 25 nonagenarian sulfonylurea‐treated patients had hypoglycemic episodes within the last 2 years, their HbA1c were all 7.0 ≤ HbA1c < 8.0, and sulfonylurea or insulin was tapered in all cases after confirming hypoglycemia. Tapering dosage was attempted in all 25 sulfonylurea‐treated nonagenarian patients, but 15 needed to continue sulfonylurea for glycemic control, and 10 continued sulfonylurea with unknown reasons from their medical records. Conclusions: Although tapering the dosage of sulfonylurea was attempted in nonagenarian patients, sulfonylurea was widely continued for glycemic control. Reverse clinical inertia may exist in some sulfonylurea‐treated nonagenarian patients. Abstract : We described the features of outpatients with diabetes aged ≥90 years old in an urban diabetes clinic in Tokyo. Though tapering dosage or withdrawal of sulfonylurea were attempted in patients aged ≥90 years old, sulfonylurea was widely continued for the glycemic control. In this study, for the first time, we showed reasons for continuing sulfonylurea for patients aged ≥ 90 years old, despite the proposal by the Joint Committee of Japan Diabetes Society and the Japan Geriatrics Society in 2016; "Glycemic control (HbA1c) goals in elderly patients with diabetes", has raised HbA1c goals and set lower limit of HbA1c for elderly patients.