Adherence to the ADA’s Glycemic Goals in the Treatment of Diabetes Among Older Americans, 2001–2018
Research Design and Methods: We conducted cross-sectional analysis of 2001-2018 National Health and Nutrition Examination Survey. We included older adults ≥65 years who had ever been told they had diabetes, had an HbA1C >6.4%, or fasting plasma glucose >125 mg/dL. Health status was categorized as good, intermediate, or poor. Being below goal was defined as taking medication despite having HbA1c ≥1% below ADA’s glycemic goals which varied by patient health status and time period. Drugs associated with hypoglycemia included sulfonylureas, insulin, and meglitinides.
Results: We included 3,539 patients. Mean HbA1c increased over time and did not differ by health status. Medication use increased from 59%-74% with metformin being the most common drug in patients with good or intermediate health, and sulfonylureas and insulin most often prescribed to patients with poor health. Among patients taking medications, prevalence of patients below goal increased while those above goal decreased from 2001-2018. Half of patients with poor health and taking medications had below-goal HbA1c; two-thirds received drugs associated with hypoglycemia. Patients with poor health who were below goal had 4.9 (95% CI: 2.3-10.4) times the adjusted odds of receiving drugs associated with hypoglycemia than healthy patients.
Conclusions and Relevance: In accordance with ADA’s newer Standards of Care, HbA1c goals were relaxed but did not differ by health status. Below-goal HbA1c was common among patients with poor health; many were prescribed medications associated with a higher risk of hypoglycemia.