Older Diabetics May Be Over-Treated

Older diabetics with multiple comorbid conditions often receive aggressive treatment regardless of their health status or blood sugar levels, according to research published in the January 12, 2015, edition of JAMA Internal Medicine.

Kasia Lipska, MD, MHS, of the Yale University School of Pharmacy, and colleagues examined the medical records of 1288 diabetics aged 65 and older and then analyzed the patients’ glycemic control levels.

Approximately 62% of patients had blood sugar levels <7%, despite the unproven benefits and possible harms of such tight glycemic control in older diabetics with complex comorbidities. Of those patients, 55% were treated with insulin or sulfonylureas medications, which the authors noted could lead to severe hypoglycemia.

Thus, the researchers concluded that a substantial amount of older adults with diabetes are over-treated.

"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%&mdash;is that it is uncertain whether this approach provides a benefit, and it could, in fact, cause greater harm," Dr. Lipska said in a press release. "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."

The researchers also determined that many older patients are not given individualized glycemic targets.

"We should use an individualized therapy approach when treating older diabetes patients," Dr. Lipska said. "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."