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Doctors urged not to overtreat older people with type 2 diabetes

DCUK NewsBot

DCUK NewsBot

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Older people with type 2 diabetes are being overtreated with harmful consequences, according to Dutch research. In the UK, clinical guidelines from the National Institute for Health and Care Excellence take the elderly and frail into account. However, many other countries are yet to follow suit. A Dutch study which looked at 319 adults aged 70 or older with type 2 diabetes showed almost 40% of those with normal HbA1c levels were being given too much medication. The research team also found that many people were considered frail, suffering from other health issues and were taking five different medicines, some of which caused hypoglycemia. Just over 20% of the older patients had suffered from hypoglycemia and almost 30 per cent had endured a fall. Despite this, their medication had not been altered. Dr Huberta Hart, from the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands, said: "Although the number of patients included in this study was small, the results give a clear signal that overtreatment in older patients with type 2 diabetes is a real problem." The definition of overtreatment was compared to the treatment guidelines laid out by the American Diabetes Association and European Association for the Study of Diabetes. The authors said that healthcare professionals should "abandon the 'one size fits all' approach and realize the possible benefits of de-intensifying blood glucose-lowering treatment". Clause 1.6.9 of the NICE guidelines for type 2 diabetes (NG28) states that clinicians should consider relaxing treatment targets in people with type 2 diabetes who are elderly or frail. In a bid to avoid over-medicating an older person, the researchers suggest type 2 diabetes guidelines should be updated to include a higher HbA1c limit. Benedict Jephcote, Editor of Diabetes.co.uk, said: "Elderly and frail people are more susceptible to the effects of overtreatment of diabetes. The NICE guidelines underline that doctors should be on the lookout for which patients may need relaxed treatment targets which may mean less intensive treatment with diabetes medication." The study results have been published in Diabetes Care. Editor's note: One of the key aims of our Low Carb Program is to help people with type 2 diabetes reduce their dependence on medication, which can be achieved through eating real, healthy food, cutting out processed food and getting regular exercise.

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Going off topic slightly, but can metformin casue a hypo? My T2 87 year old dad has been diagnosed for nearly 10 years and is on metformin. He's been given no dietary advice other than to have something sweet at tea time, and has been told not to test. I'm going to do some blood tests on him while he stays with us just to check everything is OK (he has no idea what his hbA1c reading is but he's not on maximum metformin so am assuming it's not too bad). As I don't have a fingerprick device (I just use lancets) I've been putting off the blood testing on him....
Not quite as bad as it sounds as my mum was T1 and so their diet was fairly healthy, and now she's died he retains old eating habits, but he really enjoys his afternoon snack and I'd hate to tell him it's a bad idea.
 
EllieM said:
Going off topic slightly, but can metformin casue a hypo? My T2 87 year old dad has been diagnosed for nearly 10 years and is on metformin. He's been given no dietary advice other than to have something sweet at tea time, and has been told not to test. I'm going to do some blood tests on him while he stays with us just to check everything is OK (he has no idea what his hbA1c reading is but he's not on maximum metformin so am assuming it's not too bad). As I don't have a fingerprick device (I just use lancets) I've been putting off the blood testing on him....
Not quite as bad as it sounds as my mum was T1 and so their diet was fairly healthy, and now she's died he retains old eating habits, but he really enjoys his afternoon snack and I'd hate to tell him it's a bad idea.
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It would be very unusual for anyone to hypo when on Metformin. It doesn't work that way. If his sugars were going low his liver would kick in to raise him up. Very, very strange that he was told to eat something sweet at tea time! (or at any time come to that) Are you sure he wasn't telling you a few porkies? However, at his age I wouldn't worry too much, but it would be a good idea to do some testing - morning fasting, before evening meal, 2 hours later, bedtime.
 
My father was quite "elderly and frail" at 72, and died shortly afterwards....so I think a lot of it comes from how you take care of yourself, genes, etc. etc.
 
I don't bounce as well when dropped, as I did 20 years ago, but as a septuagenian I don't consider myself 'frail' and can easily cycle 20+ miles and spend hours doing heavy work in my garden.
 
As a 77 yr old Male I consider Myself neither Old nor Frail of course there are a few things I cannot do but there always were.
and yes a few years ago My Diabetes Doctor told me That The current recommendation for people my age was 130 mg/dL whereas my previous target was 110 on asking this forum if anyone else had received this advice. The answer was no and I was advised to ignore it which I did
 
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