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

Over 20% of Chinese adults aged 60 and older live with type 2 diabetes mellitus (T2DM), according to the International Diabetes Federation. Yet, data on how well these patients manage their blood sugar—and what treatments they use—have been limited. A 2021 study in the Chinese Medical Journal sought to fill this gap by examining clinical characteristics, treatment patterns, and glycemic control in older Chinese T2DM patients.

Led by Xiao-Ling Cai and Li-Nong Ji from the Department of Endocrinology and Metabolism at Peking University People’s Hospital, along with researchers from Boehringer Ingelheim, the nationwide cross-sectional study included 1,520 patients (average age 67.7 years, 53.9% women) from 18 hospitals across China. Patients were diagnosed with T2DM using 1999 World Health Organization (WHO) criteria, and those participating in other clinical trials were excluded. The study followed ethical guidelines, with approval from all participating centers and written informed consent from every participant.

What the Study Measured

The primary goal was to find out how many patients achieved adequate glycemic control—defined as a hemoglobin A1c (HbA1c) level below 7% (a 3-month average of blood sugar). Secondary outcomes included treatment patterns, rates of hypoglycemia (low blood sugar), and diabetes-related complications (e.g., kidney, eye, or nerve damage). Researchers used multivariate logistic regression to identify factors linked to poor glycemic control.

Key Findings: Glycemic Control

Only 43.4% of patients hit the HbA1c <7% target. Control worsened with age:

  • 45.4% of patients aged 60–69 achieved the target
  • 40.5% of those aged 70–79
  • Just 31.9% of patients aged 80 and older

Kidney health also played a role. Patients with albuminuria (protein in urine, a sign of kidney damage) were less likely to control their blood sugar:

  • 48.7% of patients without albuminuria hit the target
  • 32.1% of those with microalbuminuria (mild kidney damage)
  • 38.0% of those with macroalbuminuria (severe kidney damage)

Longer diabetes duration was another barrier:

  • 53.7% of patients with T2DM for less than 1 year achieved control
  • Only 38.4% of those with diabetes for 10 years or more

Treatment Patterns: Old vs. New Drugs

Biguanides (e.g., metformin)—recommended as first-line therapy by major guidelines—were the most commonly used oral anti-diabetic drugs (OADs):

  • 8.6% of patients used biguanides alone
  • 6.4% combined biguanides with sulfonylureas (a drug class linked to higher hypoglycemia risk)

However, newer, safer medications were rarely prescribed:

  • Only 4.7% of patients used dipeptidyl peptidase-4 (DPP-4) inhibitors (low hypoglycemia risk)
  • Just 0.3% used sodium-glucose cotransporter-2 (SGLT-2) inhibitors (which also lower cardiovascular risk)
  • A mere 0.1% used glucagon-like peptide-1 (GLP-1) receptor agonists (another cardioprotective option)

Insulin use was common:

  • 15.5% of patients took insulin only
  • 28.3% took insulin plus OADs (most often biguanides or α-glucosidase inhibitors)

Complications and Hypoglycemia

Nearly 1 in 3 patients (28%) reported hypoglycemia, a dangerous side effect of some diabetes drugs. Rates were highest in insulin users:

  • 51.7% of patients on insulin alone experienced hypoglycemia
  • 34.9% of those on insulin plus OADs

Hypoglycemia led to treatment changes in 7.2% of patients overall.

Common diabetes-related complications included:

  • Cardiovascular disease (14.9%)
  • Retinopathy (eye damage, 14.4%)
  • Neuropathy (nerve damage, 13.6%)
  • Cerebrovascular disease (11.2%)

Factors Linked to Poor Control

The study found three key predictors of not meeting the HbA1c target:

  1. Older age: Patients 80+ were 40% less likely to achieve control vs. those 60–70.
  2. Albuminuria: Patients with microalbuminuria were 47% less likely to control blood sugar vs. those with normal kidney function.
  3. Longer disease duration: Patients with diabetes for 5–10 years were 32% less likely to achieve control vs. those with 10 years were 43% less likely.

What This Means for Patients and Providers

The results highlight two major concerns:

  1. Low glycemic control: Over half of older Chinese T2DM patients aren’t managing their blood sugar well, which raises their risk of complications like kidney failure, blindness, or heart disease.
  2. Treatment gaps: High use of drugs with hypoglycemia risk (e.g., sulfonylureas, insulin) and low use of newer, safer medications (e.g., SGLT-2 inhibitors, GLP-1 agonists) may explain the high rate of hypoglycemia. These newer drugs also offer cardiovascular benefits—critical for older patients, who are more likely to have heart disease.

The study also notes limitations: It included only secondary/tertiary hospitals, so outcomes in rural or community settings (where guideline adherence is often lower) may be worse.

This study was published in the Chinese Medical Journal in 2021 (Cai XL, Shen J, Ye BQ, Li Q, Clark DAS, Ji LN).

doi.org/10.1097/CM9.0000000000001674

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