November 18, 2016
A new study published in Diabetes Care found that, when evaluating glycemic control in older adults, it may be worthwhile to consider undertreatment and overtreatment vs simply looking at a standard measure of control.
Researchers identified Veterans Administration patients ≥ 65 years of age in 2012 who were taking antihyperglycemic agents in 2013. Investigators calculated patient and facility-level glycemic control rates based on a proposed out-of-range (OOR) measure that considered overtreatment (HbA1c < 7%) and undertreatment (> 9%), vs the standard measure (SM) (< 8%).
Patient-level rates and facility-level rates/rankings were calculated by age and comorbid illness burden. The study population comprised 193,689 patients with at least one significant medical, neurological, or mental health condition; 98.2% were taking a sulfonylurea and/or insulin; 55.2% were aged 65-75 years; and 44.8% were aged > 75 years. Of patients 65-75 years, 47.4% met the OOR measure (33.4% OT, 14% UT), and 65.7% met the SM.
Facility-level rates for OOR for patients aged 65-75 years ranged from 33.7% to 60.4% (median 47.4%), with a strong inverse correlation (P = -0.41) between SM and OOR performance rankings.
Among the best-performing 20% facilities on the SM, 14 of 28 ranked in the worst-performing 20% on the OOR measure; 12 of 27 of worst-performing 20% facilities on the SM ranked in the best-performing 20% on the OOR measure.
Overall, researchers concluded that facility rankings that are based on an SM (potential benefits) and OOR measure (potential risks) differ substantially; an OOR for high-risk populations can focus quality improvement on individual patient evaluation to reduce the risk for short-term harms. —Amanda Del Signore