The “one size fits all” approach to diabetics treatment may cause significant problems for older patients also suffering from other conditions. Attempting to aggressively control blood sugar with insulin and sulfonylurea drugs could lead to over-treatment and hypoglycemia (low blood sugar), Yale researchers report.
The study, which was published in JAMA Internal Medicine, found that many older patients received the same treatment as their younger counterparts, despite having other health conditions to struggle with. In patients with diabetes aged 65 and older this raises major problems – potentially even life threatening ones.
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“We treat diabetes to prevent complications of the disease by lowering blood sugar levels, but the problem with aggressively lowering blood sugars in older people — to a hemoglobin A1c below 7% — is that it is uncertain whether this approach provides a benefit, and it could, in fact, cause greater harm,” said lead author Dr. Kasia Lipska, assistant professor of internal medicine at Yale School of Medicine. “Our study suggests that we have a one-size-fits-all approach despite questionable benefits and known risks. We have been potentially over-treating a substantial proportion of the population.”
This study asks some very valid questions and shows that even though managing diabetes is very important, we need to find a way to tailor treatments for individual patients and needs.
For this study, patients were divided into three groups depending on their relative health – poor, intermediate and good. Blood sugar was considered controlled if it fell below 7%. About 62% of the patients had blood sugar levels less than 7%. Out of them, 55% were treated with either insulin or sulfonylureas medications.
“We should use an individualized therapy approach when treating older diabetes patients,” said Lipska. “Older patients who are relatively healthy may benefit if they are treated in a similar way to younger diabetes patients, but this approach might not work in older patients who often have other health issues.”
Diabetes is a term denoting a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. As at 2013, 382 million people have diabetes worldwide, with type 2 diabetes making for 90% of all cases.
Journal Reference: Kasia J. Lipska, Joseph S. Ross, Yinghui Miao, Nilay D. Shah, Sei J. Lee, Michael A. Steinman. Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control. doi:10.1001/jamainternmed.2014.7345