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Intensive glucose-lowering treatment could pose risks for adults with type 2 diabetes

People with type 2 diabetes who receive intensive glucose-lowering therapy could develop severe hypoglycemia, a new study reports.
Researchers at Mayo Clinic, Rochester, Minnesota, United States sought to examine the association and frequency of intensive glucose-lowering treatment and severe hypoglycemia.
Information was taken from more than 31,500 American adults with type 2 diabetes who were not using insulin at the start of the study and did not have a history of severe hypoglycemia.
Just over 25 per cent of patients received intensive treatment of blood sugar; nearly 19 per cent of older patients and those with co-existing illnesses also received this treatment option.
Intensive treatment was defined by a combination of how low participants’ HbA1c was and the number of diabetes drugs they were taking.
Patients who were older and had additional health conditions were almost twice as likely to experience severe hypoglycemia. Over a two-year period, intensive treatment raised this risk by an additional 77 per cent.
The type of drug which patients took made a significant difference to the rates of severe hypoglycemia. Patients on sulphonylureas or glinides, which actively stimulate the pancreas to produce more insulin, had more than a doubling in risk of severe hypos after two years. Insulin and thiazolidenediones (TZDs) were associated with modest increases in risks of severe hypoglycemia.
Lead author Dr Rozalina McCoy said: “In this study, we found that, particularly among older patients and patients with serious chronic conditions, intensive treatment nearly doubled the risk of severe hypoglycemia requiring medical attentio, including hospitalisation.
“This means that three out of 100 older or clinically complex patients with [type 2] diabetes who never had hypoglycemia before, whose [blood sugar] is within recommended targets and who are not on insulin will experience a severe hypoglycemic episode at some point over two years.”
McCoy’s team were additionally concerned because the findings do not evaluate more mild episodes of hypoglycemia, which could still cause problems for type 2 diabetes patients.
“Individualised assessment of clinical complexity, in addition to careful consideration of likely risks and benefits of intensive glucose-lowering therapy, is therefore an important part of patient-centred diabetes management,” the researchers concluded.
The findings were published online in the journal JAMA Internal Medicine.

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