Many older adults with diabetes may be overtreated for their disease, potentially leaving them more susceptible to more serious health threats as a result of adverse effects from medication, a new study warns.
Many adults reach a hemoglobin A1C level, a measure of blood sugar, of below 7%, including among adults ages 65 and older who are relatively healthy, suggest recommendations from the American Diabetes Association (PDF).
But more than half of adults ages 65 and older with diabetes registered a hemoglobin A1C level of less than 7% regardless of their health status, according to a study published Monday in JAMA Internal Medicine.
Findings were based on an analysis of data collected from the National Health and Nutrition Examination Survey from 2001 to 2010 of 1,288 adults ages 65 and older with diabetes. Patients were divided into three categories based on health status. Categories included those who were relatively healthy; those with intermediate health, defined as having complex medical histories that made self-care difficult; and those in poor health who had limited life expectancy due to significant comorbid illness and impairments.
In those with intermediate to poor health, such tight control of blood sugar raised the possibility of developing hypoglycemia, or low blood sugar, increasing their risk for hospitalization due to adverse drug events.
“Although the harms of intensive treatment likely exceed the benefits for older patients with complex/intermediate or very complex/poor health status, most of these adults reached tight glycemic targets between 2001 and 2010,” the study concluded. “Most of them were treated with insulin or sulfonylureas, which may lead to severe hypoglycemia. Our findings suggest that a substantial proportion of older adults with diabetes were potentially overtreated.”
Of those studied, 62% registered a hemoglobin level less than 7%. Of that group, two-thirds were treated with either insulin or sulfonylurea medicines—drugs that increase insulin levels that are usually prescribed for those with Type 2 diabetes despite being in intermediate or poor health.
“These vulnerable adults are unlikely to experience the benefits of intensive glycemic control and instead are likely to experience harms from treatment, such as hypoglycemia and other adverse effects.” according to the study. “Recognition of both the harms and benefits of glycemic control is critical for patients and physicians and other healthcare professionals to make informed decisions about glucose-lowering treatment.”
American Diabetes Association treatment guidelines (PDF) recommend a hemoglobin A1C level of 8% or less for those in intermediate health, and 8.5% or less for those patients with short life expectancies and those with extensive comorbidities.
Roughly 12 million U.S. adults ages 65 and older are estimated to have diabetes, a quarter of the elderly population. Older adults with diabetes are at higher risk of developing a number of other chronic conditions, including kidney disease, hypertension, cardiovascular disease and stroke.
The study authors acknowledged a number of limitations to their findings, most notably the inability to determine whether overtreatment directly resulted in harm.
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