Study associates advanced chronic kidney disease and poor glycemic control with increased hospitalization in older type 2 diabetes patients

An observational study of diabetic adults aged 75 and older found that advanced chronic kidney disease and poor glycemic control are the primary drivers of hospitalization, whereas metformin and incretin-based therapies are associated with fewer hospital days.

Researchers evaluated associations between glycemic control, kidney function, and hospitalization among 1,446 individuals aged 75 years and older with type 2 diabetes (T2D) in Sweden, utilizing 2018 and 2019 healthcare database records.

Hospital days were significantly higher among individuals with advanced chronic kidney disease (CKD stage 4-5, eGFR < 30 mL/min/1.73 m²), presenting a relative risk (RR) of 1.93 (95% CI: 1.71-2.17).

Poor glycemic control (HbA1c > 70 mmol/mol) was also associated with increased hospital days, with an RR of 1.44 (95% CI: 1.28-1.61).

While primary care encounters were frequent (physician visits: 4.6 [SD 3.7]; nurse visits: 9.0 [SD 9.3]) and associated with CKD status, they were not associated with glucose dysregulation.

The use of metformin and incretin-based therapies was associated with fewer hospital days, whereas insulin use was associated with an increased hospitalization burden.

The findings demonstrate that in geriatric patients with T2D, the burden of secondary care hospitalization is driven more heavily by advanced renal impairment than by glucose dysregulation alone.

This emphasizes the clinical importance of prioritizing organ-protective metabolic therapies, such as incretin-based drugs and metformin, over regimens that may not offer the same renal or cardiovascular advantages in the oldest-old population.

These real-world outcomes support the ongoing market shift toward GLP-1 receptor agonists and other incretin-based treatments within older populations to manage systemic aging and diabetes-related multimorbidity.

Therapeutic developers targeting metabolic aging and longevity may find further validation for prioritizing dual-benefit mechanisms that preserve kidney function alongside improving metabolic markers.

Future clinical guidelines may place greater emphasis on eGFR-based risk stratification and outpatient management protocols specifically tailored to diabetic patients over the age of 75.

Prospective studies comparing the long-term healthcare utilization impact of newer dual-incretin therapies against conventional regimens in geriatric populations.