Older patients over-treated for diabetes, research suggests

Wed, 14 Jan 2015
Older people with diabetes may not benefit from intensive blood glucose-lowering strategies, according to new research.

The study, published in JAMA Internal Medicine, analysed the glycemic control of older patients with diabetes, with the aim of discovering any possible over-treatment of the disease.

The American Diabetes Association (ADA) suggests an HbA1c target of less than seven per cent, while the American Association of Clinical Endocrinologists (AACE) places that figure at 6.5 per cent.

The study

However, the researchers discovered that older diabetes patients are more susceptible to hypoglycemia, suggesting that such strict targets may in fact place them in a dangerous position.

The data of 1,288 adults aged 65 and over with a previous diagnosis of diabetes were examined by the research team. Particiants were placed into one of three groups, defined by the state of their health. The authors defined these groups as: "Those who are relatively health, those with complex medical histories for whom self-care may be difficult and those with a very significant comorbid illness and functional impairments, many of whom may have limited life expectancy."

50.7 per cent of the participants were relatively healthy, 28.1 per cent had complex medical histories, and 21.2 per cent had very poor health.

The results

When the researchers examined the participants' glycemic control, they found that 61.5 per cent had tight glycemic control: that is, an HbA1c level of less than seven per cent.

Tight glycemic control was observed in: 62.8 per cent of the relatively healthy, 63 per cent of those with a complex medical history, and 56.4 per cent of those with poor health.

Around two-thirds of older patients with either complex or poor health, therefore, managed to attain tight glycemic control, and yet their state of health was still a concern.

What do the results suggest?

The authors explained: "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."

The study is not without limitations: some of the conditions used to categorise health status are more consistently linked with hypoglycemia than others. The categories were defined, however, based on a framework recommended by the ADA and American Geriatrics Society (AGS).

The authors concluded: "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."
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