Clinical characteristics and outcomes of the oldest old people with type 2 diabetes - perspective from a tertiary diabetes center in Thailand

Background: Advance in medicine has led to an increase in life expectancy of elderly diabetic patients especially on the growing population called the "oldest old", those in their mid-80s upwards. The aim of this study is to describe clinical characteristics and outcomes of "oldest old" patients in a specialized diabetes center. Methods: A retrospective review was conducted on medical records of type 2 diabetes who were older than 85 years at Theptarin hospital from September 2014 to August 2015. Results: During the study period, there were 143 oldest old diabetic patients who visited our hospital regularly. Of the 133 active follow-up patients (median time of follow-up 15 years, range 1-30 years), 70.7 % was female, the mean age of onset was 68.3 +/- 11.5 years and duration of diabetes was 20.1 +/- 11.1 years. According to the Charlson co-morbidity index (CCI), 35.3 % of patients were classified as having severe co-morbidities. The mean A1C, blood pressure, LDL were 6.7 +/- 1.1 %, 132/65 mmHg and 80 +/- 29 mg/dl respectively. 66.9 % of patients had tight glycemic control (A1C <7 %) while 12.0 % had poor control (A1C >8 %). Oral hypoglycemic agent (OHA) dual therapy was the most common treatment (26.3 %) followed by OHA monotherapy (22.6 %), insulin alone (19.5 %), diet therapy alone (12.7 %), and insulin plus OHA (8.3 %). Hypoglycemia was found in 10.5 % of patients in previous 12 months. Diabetic retinopathy, chronic kidney disease, cardiovascular disease, and stroke were presented in 23.4, 54.9, 15.8, 18.0 % of patients, respectively. Among patients whose received diabetic medications and resulted in very low level of A1C (A1C less than 6.0 %), only 20.0 % underwent deintensification. Conclusions: Our results revealed that real-world clinical outcomes of extreme elderly diabetic patients were diverse and being too "aggressive" diabetes treatment with older patients did occur frequently. Decision making in older people with diabetes is complex as chronic co-morbidities are very common.