Missed Opportunities to Address Hypoglycemia Risk in Older Adults with Type 2 Diabetes during Symptom-Driven Primary Care Visits

Older adults with type 2 diabetes (T2D) treated with insulin and/or sulfonylureas (SUs) are at increased risk for hypoglycemia-related adverse events (e.g. falls, decreased quality of life, and death). Because aging is associated with changes in physiology, visual acuity, and dietary habits, diabetes treatment regimens require regular re-assessment. However, despite the importance of ensuring safe diabetes care in older adults, prior research has shown that diabetes is often not addressed during primary care visits due to limited time and competing demands. We tested the hypothesis that diabetes management in primary care occurs less frequently during visits scheduled for acute symptoms/concerns (i.e., “reactive visits”) vs. pre-scheduled annual/physical exam visits intended for health maintenance (i.e., “proactive visits”). We conducted structured chart abstraction for 123 older adults with T2D prescribed insulin and/or SUs to examine the association of visit context (reactive vs proactive) with physician-documented diabetes management, defined as any documentation of diabetes control, blood sugar levels, or diabetes-related medications. Patients were 78.6 ± 3.65 years old, 52.8% were women, pre-visit HbA1c was 7.4% ±0.9%. We found that diabetes documentation in these patients was much less frequent in reactive vs. proactive visits (50.7% vs. 69.8%, p = 0.02). In a logistic model, this association remained significant after controlling for demographic differences (aOR 2.4, 95% CI = 1.1-5.3). In this model, HbA1c ≥8% was also independently associated with diabetes documentation (aOR 3.3 [1.1-10.1]). Treatment with insulin or SUs exposes aging adults to a high risk of hypoglycemia, especially during times of change. Although chart documentation may underestimate actual visit interactions, our results suggest that visits made to discuss acute concerns are a missed opportunity to review and address diabetes care in high-risk patients. Disclosure E.Tang: None. I.Peterson: None. C.Board: None. R.W.Grant: None. Funding Patient-Centered Outcomes Research Institute (CDR-2019C1-16126)