Risk factors and management of diabetes in elderly French patients

Abstract Aims The aim of this study was to assess the characteristics of elderly diabetic patients, evaluate the relationship between glycaemic control and diabetes complications, and compare the day-to-day management of such patients with the published recommendations. Methods The study included 238 elderly diabetic patients, for whom data for the past six months’ medical history, clinical examination (including ocular fundus) and standard biological tests were collected. Results The patients’ mean age was 82.2 ± 7.2, HbA 1c value was ≥ 8.5% in 24% of patients and the mean number of cardiovascular risk factors (CVRF) was 4.1 ± 0.7 per patient. Dementia or cognitive impairment was present in 68% of patients. Estimated glomerular filtration rate was 30 mL/min or lesser than 16%. Retinopathy was present in 37% of patients, and 64% had a history of infection in the past six months; more than 50% of patients took insulin. The prevalence of retinopathy, cognitive dysfunction and infections were significantly less frequent in patients with HbA 1c ≤ 6.5%. There was a positive correlation between the number of CVRF and the number of cardiovascular anomalies ( r  = 0.19, P 1c , standard paraclinical tests were performed in less than 50% of patients. There was positive agreement between day-to-day HbA 1c and HbA 1c target values in 36% of patients. Conclusion Complications and/or associated diseases were more frequent in this cohort of elderly diabetic patients compared with those in studies not based on clinical examinations. Our results highlight the inadequate management, given the frequent discrepancy between day-to-day HbA 1c and HbA 1c targets, of such patients.