Does comorbidity affect the benefit of intensive glycemic control in older patients with type 2 diabetes mellitus?

Abstract

This Practice Point commentary discusses a computer-based decision analysis by Huang et al. that assessed the effect of comorbid illnesses and functional status on the benefits of intensive glycemic control (HbA_1c 7.0%) in hypothetical older patients with type 2 diabetes mellitus (T2DM). The expected benefits of intensive glycemic control ranged from 51–116 additional days of quality-adjusted life expectancy (quality-adjusted days). Expected benefits decreased with increasing age or number of comorbidities, and increased with duration of T2DM. We highlight the issues to consider in the extrapolation of theoretical models to the clinical setting. In the examined study, the input data were several decades old, interpretation of the mean quality-adjusted days gained lacked comparative benchmarks, and a 'survivor effect' probably accounted for the increased benefit associated with an increased duration of T2DM. Nevertheless, the data do suggest that the benefits of intensive control might be diminished in older patients with multiple comorbidities and functional impairments.