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Insulin may do more harm than good in elderly patients with type 2 diabetes

An American study has found that whilst insulin can marginally increase life expectancy in elderly patients, the accompanying side effects may outweigh the benefits.
The research team included researchers from the University of Michigan as well as from University College London. The results of the study are likely to prompt reconsideration of treatment targets in elderly patients with type 2 diabetes within the UK.
Participants with type 2 diabetes were drawn from the National Health and Nutrition Examination Study, a study run by the United States’ Centers for Disease Control and Prevention. The researchers used statistical modelling to compare the effects of blood glucose lowering interventions by tablets and by insulin.
The researchers found that, on average, a 45 year old person with type 2 diabetes that reduced their HbA1c by 1% (11 mmol/mol), would benefit from an additional 10 months of healthy life as long as they did not regard their treatment as a significant burden. For a 75 year old that did not regard their treatment as burdensomen, a 1% decrease in HbA1c would result in the benefit of an additional 3 weeks of healthy life.
By comparison patients that regarded their treatment as a significant burden experienced a reduction in healthy life years. Whilst tablets tend to have a relatively low burden on life, insulin, which requires regular injections and can often result in too low blood sugar levels (hypoglycemia), is much more likely to be viewed as a burden.
The researchers conclude that whilst a significant reduction in HbA1c will offer a longer life for middle aged patients, for elderly patients with an HbA1c of under 9% (75 mmol/mol), intensive treatment particularly if it is viewed as a burde, is likely to do more harm than good.
In response to the results of the study, Director of Health Intelligence at Diabetes UK, Simon O’Neill states: “This study highlights the importance of looking at the individual needs of the person with type 2 diabetes, rather than adopting a blanket approach. It also underlines how vital it is that healthcare professionals and people with diabetes work closely together to jointly decide what the best treatment options are for that person and weighing up the potential benefits and side-effects, which will vary from person-to-person, needs to be at the centre of that discussion.”

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