Recent clinical guidelines recommend avoiding “diabetes overtreatment” in older individuals with type 2 diabetes (T2D), which refers to excessively low glycemia that increases the risk of side effects like hypoglycemia. This study, part of the HYPOAGE cohort, used continuous glucose monitoring (CGM) data to assess the incidence and predictive value of hypoglycemia associated with these proxy definitions in older insulin-treated patients with T2D. The researchers found no significant association between HbA1c-based proxy definitions of overtreatment and the occurrence of hypoglycemia.

The study highlighted the high prevalence of hypoglycemia, particularly in overtreated patients, but found that both fixed and individualized HbA1c thresholds had low predictive value for hypoglycemia. These findings challenge the reliance on HbA1c alone as a marker for overtreatment, suggesting that CGM-based definitions may be more effective. However, further research is needed to validate these findings and explore alternative methods for identifying older patients at risk for hypoglycemia due to intensive glucose-lowering therapies. This study emphasizes the need for revised approaches to managing diabetes in older patients to reduce the risks associated with overtreatment.

Reference: Christiaens A, Boureau AS, Guyomarch B, et al. Diabetes Overtreatment and Hypoglycemia in Older Patients With Type 2 Diabetes on Insulin Therapy: Insights From the HYPOAGE Cohort Study. Diabetes Care. 2025;48(1):61-66. doi: 10.2337/dc24-1058.