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Jan 13, 2015 01:07 AM EST

One-Size-Fits-All Approach Could Lead to Over-Treatment in Older Diabetes Patients


In older patients with multiple medical conditions, some diabetes treatments could lead to over-treatment and hypoglycemia (low blood sugar), according to recent study.

Researchers at Yale School of Medicine found that many older diabetes patients received aggressive treatment -- aggressively controlling blood sugar with insulin and sulfonylurea drugs -- for their disease regardless of their health status and blood sugar levels. In patients with diabetes age 65 and older, this could result in hypoglycemia, a serious health threat, which can lead to confusion, coma, and even death.

"We treat diabetes to prevent complications of the disease by lowering blood sugar levels, but the problem with aggressively lowering blood sugars in older people -- to a hemoglobin A1c below 7 percent -- is that it is uncertain whether this approach provides a benefit, and it could, in fact, cause greater harm," Dr. Kasia Lipska, lead author of the study, said in a statement. "Our study suggests that we have a one-size-fits-all approach despite questionable benefits and known risks. We have been potentially over-treating a substantial proportion of the population."

For the study, Lipska and her colleagues conducted a cross-sectional study that analyzed the health records of 1,288 patients age 65 and older with diabetes from the National Health and Nutrition Examination Survey (NHANES). The team analyzed glycemic control levels recorded in NHANES between 2001 and 2010.

Patients were divided into three groups based on their health status: very complex/poor, complex/intermediate, and relatively healthy. Blood sugar was considered controlled if it fell below 7 percent.  About 62 percent of the patients had blood sugar levels less than 7 percent and this did not differ across health status. Of those patients, 55% were treated with either insulin or sulfonylureas medications.

"We should use an individualized therapy approach when treating older diabetes patients," said Lipska. "Older patients who are relatively healthy may benefit if they are treated in a similar way to younger diabetes patients, but this approach might not work in older patients who often have other health issues."

The findings are detailed in JAMA Internal Medicine.

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