helping an older person with type 2 diabetes

Treatment should be individualised for older people with type 2 diabetes and other health conditions, according to researchers.

A new study has found that maintaining tight glucose control may not always be the best approach for some as it can lead to hypoglycemia or low blood sugar.

Lead study author Rozalina McCoy, a primary care physician and endocrinologist at Mayo Clinic in the US, said: “Patients who are older or who have serious health conditions are at high risk for experiencing hypoglycemia, which, for them, is likely to be much more dangerous than a slightly elevated blood sugar level.

“At the same time, the benefits of intensive treatment usually take many years, even decades, to realise. So many patients may be treated intensively and risk hypoglycaemia for no real benefit to them.”
However, she said their findings suggest a different approach should be adopted for younger people with diabetes.

She said: “These patients should be treated more aggressively, meaning that we should not shy away from using insulin or multiple medications to lower the A1C. We need to ensure that all our patients with diabetes receive high-quality care and are able to manage their disease to prevent complications both now and in the future.

“What makes it even worse is that patients who are treated intensively are those who are most likely to be harmed by it. But at the same time, patients who would benefit from more intensive treatment are not receiving the basic care that they need. The paradox and misalignment of treatment intensity with patients’ needs is really striking.”

The trial involved looking at the health data of more than 194,000 people with type 2 diabetes. The findings showed those who maintained an average of 7.7% in their HbA1c levels were aged between 18 and 44.

Those who achieved an average HbA1c of 6.9% were aged about 75. The average HbA1c levels among those with no other coexisting illnesses was 7.4% compared to 7% of those who did have other health conditions, such as cancer, kidney disease or dementia.

The researchers concluded: “Patients least likely to benefit from intensive glycaemic control and most likely to experience hypoglycemia with insulin therapy were most likely to achieve low HbA1c levels and to be treated with insulin to achieve them.

“These HbA1c levels reflect HbA1c levels achieved by the patient, not necessarily HbA1c levels pursued by the clinician.”

The findings have been published in BMJ Open Diabetes Research & Care.

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