Risk factors and management of diabetes in elderly French patients

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 < 0.001). With the exception of HbA(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. (C) 2008 Elsevier Masson SAS. All rights reserved.