Characteristics, Treatment Patterns, and Glycemic Control of Older Type 2 Diabetes Mellitus Patients in China

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Characteristics, Treatment Patterns, and Glycemic Control of Older Type 2 Diabetes Mellitus Patients in China

The prevalence of type 2 diabetes mellitus (T2DM) among older adults (≥60 years) in China exceeds 20%, representing a significant public health challenge. Compared to younger patients, older individuals with diabetes face lower rates of achieving adequate glycemic control (hemoglobin A1c [HbA1c] <7.0%) and a heightened risk of hypoglycemia. Despite these concerns, limited data exist on the clinical characteristics and treatment patterns specific to this demographic in China. A nationwide cross-sectional study conducted across 18 Chinese hospitals between March and December 2017 aimed to address this gap by examining glycemic control outcomes, treatment approaches, and factors influencing poor glycemic management in older T2DM patients.

Study Design and Methodology

The study enrolled 1,520 participants (mean age: 67.7 ± 5.9 years; 53.9% female) diagnosed with T2DM according to the 1999 World Health Organization criteria. Exclusion criteria included participation in other clinical trials. Ethics approval was obtained from all participating centers, and informed consent was collected from participants. The primary outcome was the proportion achieving HbA1c <7%, while secondary outcomes encompassed treatment patterns, hypoglycemia incidence, and diabetes-related complications. Multivariate logistic regression identified predictors of poor glycemic control, with results expressed as adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Glycemic Control Outcomes

Only 43.4% of participants achieved the HbA1c target of <7%. Glycemic control rates varied significantly across subgroups:

  • Age: 45.4% of patients aged 60–69 years achieved the target, compared to 40.5% in the 70–79 age group and 31.9% in those ≥80 years.
  • Albuminuria status: Target attainment was highest in patients without albuminuria (48.7%), followed by those with macroalbuminuria (38.0%) and microalbuminuria (32.1%).
  • Disease duration: Patients with ≤1 year of diabetes had a 53.7% success rate, whereas those with >10 years of disease duration dropped to 38.4%.

Multivariate analysis revealed that older age (OR for ≥80 years vs. 60–69 years: 0.60; 95% CI: 0.35–1.05), presence of albuminuria (OR for microalbuminuria vs. normal: 0.53; 95% CI: 0.41–0.68), and longer diabetes duration (OR for >10 years vs. ≤1 year: 0.57; 95% CI: 0.41–0.79) were independently associated with failure to achieve glycemic targets.

Treatment Patterns

Antidiabetic therapies were categorized as follows:

  • Oral antidiabetic drug (OAD) monotherapy: 16.8% of patients. Biguanides (8.6% of total) were the most prescribed, followed by α-glucosidase inhibitors (3.9%) and sulfonylureas (2.7%).
  • OAD combinations: 28.7% received dual or triple therapy. Common combinations included biguanide + sulfonylurea (6.4%), biguanide + α-glucosidase inhibitor (4.7%), and α-glucosidase inhibitor + sulfonylurea (3.2%). Triple therapy involving biguanide, α-glucosidase inhibitor, and sulfonylurea accounted for 5.1%.
  • Insulin-based regimens: 28.3% used insulin combined with OADs, while 15.5% relied on insulin monotherapy. Biguanides (6.1%) and α-glucosidase inhibitors (5.9%) were frequently paired with insulin.
  • Newer agents: Dipeptidyl peptidase-4 (DPP-4) inhibitors were prescribed to 4.7% of patients, while sodium-glucose cotransporter-2 (SGLT-2) inhibitors (0.3%) and glucagon-like peptide-1 (GLP-1) receptor agonists (0.1%) were rarely used.
  • Non-pharmacological management: 10.1% received diet/exercise interventions alone or no treatment.

Hypoglycemia and Complications

Hypoglycemia occurred in 28.0% of participants, with higher rates observed in specific subgroups:

  • Albuminuria patients: 30.3% experienced hypoglycemia.
  • Treatment regimens: Hypoglycemia incidence was 15.3% with OAD monotherapy, 20.9% with OAD combinations, and 51.7% with insulin monotherapy. Sulfonylurea-containing regimens, such as biguanide + sulfonylurea (25.5% hypoglycemia rate), were particularly problematic.

Macrovascular and microvascular complications were prevalent:

  • Cardiovascular disease: 14.9%
  • Retinopathy: 14.4%
  • Neuropathy: 13.6%
  • Cerebrovascular disease: 11.2%
  • Peripheral vascular disease: 8.8%
  • Diabetic kidney disease: 8.6%

Clinical Implications and Limitations

The study highlights critical gaps in diabetes management for older Chinese adults. Despite international guidelines advocating individualized glycemic targets and safer therapeutic options, the reliance on sulfonylureas and insulin—agents associated with hypoglycemia—remains high. Conversely, newer classes like SGLT-2 inhibitors and GLP-1 receptor agonists, which offer cardiovascular benefits and lower hypoglycemia risk, were underutilized. This mismatch likely contributes to the elevated hypoglycemia rates (28.0% overall) and suboptimal glycemic control.

Notably, the study’s focus on tertiary and secondary hospitals limits generalizability to community or rural settings, where guideline adherence may be poorer. Additionally, the cross-sectional design precludes causal inferences between treatment patterns and outcomes.

Conclusion

Over half of older Chinese T2DM patients fail to achieve adequate glycemic control, with older age, albuminuria, and prolonged disease duration identified as key barriers. Current treatment patterns prioritize older drug classes with higher hypoglycemia risks, underscoring the need for broader adoption of guideline-recommended therapies. Future efforts should emphasize individualized treatment plans, enhanced monitoring for albuminuria, and increased accessibility to newer antidiabetic agents to improve outcomes in this vulnerable population.

doi.org/10.1097/CM9.0000000000001674

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