Optimizing type 2 diabetes management in older adults with cancer through comprehensive geriatric assessment-guided medication reviews: a monocentric retrospective study

Type 2 diabetes mellitus (T2DM) and cancer frequently coexist in older adults, posing complex therapeutic management challenges, particularly due to polypharmacy, frailty and the risk of hypoglycemia. Although individualized glycemic targets and a personalized therapeutic approach are recommended, real-world prescribing practices may deviate from these guidelines. To assess the alignment of pharmacological T2DM management with French guidelines in older adults with cancer undergoing comprehensive geriatric assessment (CGA)-guided medication review (MR) prior to systemic cancer treatment. We conducted a retrospective monocentric observational study including older outpatients aged ≥ 65 years with cancer and T2DM referred for CGA-guided MR at the geriatric oncology day unit of Marseille University Hospital between 2022 and 2023. Diabetes-related therapeutic issues (DTI) were identified, and associated factors were analyzed. Among the 189 patients included (median age: 79.2 years (IQR 75.8–83.7, min. 66, max. 93), 91% were frail or dependent, and 89.4% received ≥ 5 medications daily. The mean HbA1c level was 6.89 ± 1.03%, and 64.0% had HbA1c values outside their individualized target. DTI were observed in 67.7% of patients, mainly due to overly strict glycemic control and the use of hypoglycemia-prone agents. Multivariate analysis showed that age ≥ 75 years (p < 0.05), HbA1c below target (p < 0.001) and the use of ≥ 3 antidiabetics (p < 0.05) were significantly associated with DTI. This study highlights a tendency toward overtreatment of T2DM in frail older adults with cancer. CGA-guided MRs, conducted collaboratively between geriatricians and pharmacists, allow better alignment with guidelines, reduce hypoglycemia risk, and support individualized care. Integrating these reviews before cancer treatment may enhance safety and clinical outcomes in this high-risk population.