Glycated hemoglobin (A1c) values and antidiabetic treatment deprescription in hospitalized nonagenarians with type 2 diabetes

Abstract

Introduction Type 2 diabetes mellitus is highly prevalent among older adults and associated with frailty, functional decline, and increased healthcare utilization. Evidence on metabolic control and therapeutic management in hospitalized nonagenarians remains scarce, particularly in low- and middle-income country settings. This study aimed to describe glycated hemoglobin (A1c) and antidiabetic treatment modifications during hospitalization in nonagenarians with type 2 diabetes, within the context of their clinical, functional, and geriatric characteristics. Materials and methods A descriptive, retrospective, cross-sectional study based on an institutional registry from the geriatric service of a high-complexity hospital in Bogotá, Colombia (2022–2024). Individuals aged ≥90 years with a history of type 2 diabetes mellitus documented at admission were included. A1c values, antidiabetic treatment at admission and discharge and geriatric characteristics were analyzed descriptively. Results Among 195 nonagenarians, mean age was 92 ± 2 years and 60.00% were women. Infectious conditions were the most frequent admission diagnoses. Median Barthel Index score was 55 points (IQR 20–80); frailty (CFS ≥ 5) was identified in 89.20%, delirium at admission in 39.49%, and major neurocognitive disorder in 16.41%. Of patients with formal nutritional assessment (n = 103), 52.43% had moderate-to-severe malnutrition. Polypharmacy was present in 80.00%, with a median of 7 medications (IQR 5–9). Despite this clinical burden, 74.38% of patients with available A1c (n = 121) had values <7.5%, suggesting potential overtreatment. At discharge, the proportion without antidiabetic pharmacological treatment increased from 26.15 to 46.20%, with reductions in metformin, DPP-4 inhibitors, and insulin prescriptions, and an increase in SGLT-2 inhibitor use. Conclusion The coexistence of low A1c values and high burden of frailty, malnutrition, and polypharmacy reveals a critical discordance between therapeutic intensity and clinical status. These findings highlight a gap in ambulatory therapeutic review and support the need for individualized goals, deprescription protocols, and interdisciplinary care models bridging hospital, community, and domiciliary settings, a public health priority for aging populations in Latin America.