Glycaemic control of Type 2 diabetes in older patients visiting general practitioners: An examination of electronic medical records to identify risk factors for poor control.

Objective: To investigate factors associated with glycaemic control of diabetes in older patients in the general practice setting in metropolitan Melbourne, Australia.

Method: This retrospective study used the data from 10,257 patients aged ≥ 65 years with Type 2 diabetes from the Melbourne East Monash General Practice Database (MAGNET), 2009-2014. Poor glycaemic control was defined as HbA1c ≥ 9.0%. Univariate and multivariate analyses were conducted to assess the association between risk factors and glycaemic control.

Results: Of the total 10,257 patients, 6819 (66.5%) had their HbA1c recorded within a period of 2 years prior to their last GP visit. Between 4% and 6% had HbA1c level ≥ 9.0%. Robust predictors of poor glycaemic control were found to be decreasing age group (OR = 0.77, 95% CI: 0.65-0.90) and prescribed insulin (OR = 2.83, 95% CI: 2.41-3.32).

Conclusion: One third of older patients with Type 2 diabetes did not have HbA1c recorded in the previous 2 years, despite clinical guidelines recommending at least annual testing. Many older patients had good glycaemic control, however the findings indicate that those aged 65-74 and those prescribed insulin may require special care and management to achieve this.