A US survey shows that older people with type 2 diabetes do not want to have their diabetes treatment relaxed as they get older.

The results of the survey show that the wishes of elderly people in the US are counter to the recommendations laid out by the American Diabetes Association (ADA).

The ADA guidelines recommend that blood glucose targets be widened during older age, particularly in people with diabetes complications and/or other health conditions. The guidelines also raise the issue that ‘overtreatment’ of the elderly is common and that medications with a low risk of hypoglycemia are preferred.

818 participants, aged 65 or older, were surveyed and the answers analysed by Johns Hopkins Medicine researchers.

The research team found that 60% of those surveyed did not agree with the ADA guidance that those who have had diabetes for a long time should be given less aggressive treatment.

76% of the respondents disagreed that people with diabetes complications should be given less aggressive treatment and felt that treatment should be more aggressive.

47% of those surveyed felt that none of the seven factors, listed by the ADA, were important enough to stop a medication being taken.

The survey presents an interesting dilemma for healthcare. On one hand, the guidelines towards less aggressive treatment with medication in older age is there to protect people who may be developing frailty. On the other hand, there is also the care aspect of respecting an individual’s choice of treatment.

Lead researcher Dr Nancy Schoenbor, associate professor of geriatric medicine, Johns Hopkins Medicine, said: “What our study found is that many geriatric patients, 65 years or older, with type 2 diabetes perceive their treatment plans much differently than do their care providers, and may be more likely to choose a more aggressive treatment plan than what guidelines recommend, which poses greater risk for complications, injury or even death.

“The current American Diabetes Association guidelines for managing type 2 diabetes aren’t intuitive to patients, and we need to do a better job helping them understand the benefits and consequences of making changes to treatment regimens that must evolve over time on an individualized basis.”

The study is published in the JAMA Internal Medicine journal.

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