Frailty and overtreatment in older adults with type 2 diabetes in an Argentine health system.

OBJECTIVES

To describe the clinical and sociodemographic characteristics of people aged 65 years or older with type 2 diabetes mellitus, estimate the prevalence of frailty, and explore its association with metabolic control and pharmacological regimens used.

METHODS

We conducted a cross-sectional study with consecutive sampling of patients, active members of an integrated health service network in Argentina as of March 1st, 2022. Frailty was assessed using the Electronic Screening Index of Frailty, considering frail those with ≥ 9 coded clinical conditions. Glycemic control was defined according to individualized HbA1c goals (<7% non-frail, <8% frail), and overtreatment as the use of drugs with a high risk of hypoglycemia (insulin, sulfonylureas, and/or glinides) in patients at goal.

RESULTS

A total of 5,937 individuals (mean age, 78 years; 20% older than 85 years) were included. Hypertension and dyslipidemia were the most prevalent comorbidities, and 68% had polypharmacy. Frailty was 8.92% (95%CI, 8.21-9.68), doubling in individuals older than 85 years. Frail patients had more chronic complications and achieved glycemic goals more frequently (57% vs 42%), but at the expense of greater use of risky drugs (37% vs 20%) and overtreatment (23.7% vs 5.9%; aOR, 5.00; 95%CI, 3.88-6.45).

CONCLUSIONS

Frailty was associated with a higher risk of overtreatment. It is essential to implement individualized management strategies, deprescribing, and adjusting goals according to functional status. Based on this real-world evidence, we seek to contribute elements for a critical review of current policies and strategies in Latin America.