ArticleDiabetes spectrum : a publication of the American Diabetes Association2022
Using an Electronic Health Record and Deficit Accumulation to Pragmatically Identify Candidates for Optimal Prescribing in Patients With Type 2 Diabetes.
Article in Diabetes spectrum : a publication of the American Diabetes Association, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Article
- Medication Use by Older Adults with Frailty: A Scoping Review.Pharmacy (Basel, Switzerland) · 2025Review
- The Relationship of Frailty with Surgical and Laser Treatment for Patients with Glaucoma.Clinical ophthalmology (Auckland, N.Z.) · 2025Article
- Cross-sectional and longitudinal associations among healthcare costs and deficit accumulation.Journal of the American Geriatrics Society · 2024Article
- New horizons in frailty identification via electronic frailty indices: early implementation lessons from experiences in England and the United States.Age and ageing · 2024Article
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Authors and funding
9 authors.
Funding
Abstract
Objective: Despite guidelines recommending less stringent glycemic goals for older adults with type 2 diabetes, overtreatment is prevalent. Pragmatic approaches for prioritizing patients for optimal prescribing are lacking. We describe glycemic control and medication patterns for older adults with type 2 diabetes in a contemporary cohort, exploring variability by frailty status. Research Design and Methods: This was a cross-sectional observational study based on electronic health record (EHR) data, within an accountable care organization (ACO) affiliated with an academic medical center/health system. Participants were ACO-enrolled adults with type 2 diabetes who were ≥65 years of age as of 1 November 2020. Frailty status was determined by an automated EHR-based frailty index (eFI). Diabetes management was described by the most recent A1C in the past 2 years and use of higher-risk medications (insulin and/or sulfonylurea). Results: Among 16,973 older adults with type 2 diabetes (mean age 75.2 years, 9,154 women [53.9%], 77.8% White), 9,134 (53.8%) and 6,218 (36.6%) were classified as pre-frail (0.10 < eFI ≤0.21) or frail (eFI >0.21), respectively. The median A1C level was 6.7% (50 mmol/mol) with an interquartile range of 6.2-7.5%, and 74.1 and 38.3% of patients had an A1C <7.5% (58 mmol/mol) and <6.5% (48 mmol/mol), respectively. Frailty status was not associated with level of glycemic control ( Conclusion: Treatment with insulin and/or a sulfonylurea to an A1C levels <7.5% is common in frail older adults. Tools such as the eFI may offer a scalable approach to targeting optimal prescribing interventions.
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Registered trials
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