This article is more than 5 years old. Information may no longer be current.
Older adults with diabetes may be overtreated
A high percentage of older adults with diabetes who have relatively poor health status maintain tight blood glucose control with insulin and sulfonylureas, suggesting that they may be overtreated, according to recent study findings.
These agents can lead to hypoglycemia, and their risks are likely to exceed their benefits for these patients.
Kasia J. Lipska, MD, MHS, of the department of internal medicine at Yale School of Medicine, and colleagues evaluated data from the National Health and Nutrition Examination Survey compiled from 2001 to 2010 on 1,288 adults aged at least 65 years who had diabetes and an available HbA1c measurement. The goal was to determine the prevalence of potential overtreatment of diabetes.
Kasia J. Lipska
Participants were divided into the following three groups based on health status: very complex/poor (21.2%), complex/intermediate (28.1%), and relatively healthy (50.7%). An HbA1c level of less than 7% was considered tight glycemic control.
More than half of participants (61.5%) had an HbA1c level less than 7% (tight), and this proportion did not differ across health status categories (P=0.26).
Insulin or sulfonylureas were used as treatment in 54.9% of participants with HbA1c levels less than 7%; this proportion did not differ across health status categories (P=0.14).
During the study period, no specific changes were found in the trends of participants with HbA1c levels less than 7% (P=.34) or those with HbA1c levels less than 7% with complex/intermediate or very complex/poor health (P=.27). The number of relatively healthy participants with HbA1c levels less than 7% treated with insulin or sulfonylureas decreased during the study period (P=.05). Treatment with insulin or sulfonylureas among participants with complex/intermediate or very complex/poor health with HbA1c levels less than 7% remained stable (P=.65).
“For more than a decade, the American Geriatrics Society guidelines and the Veteran Affairs Department of Defense guidelines have recommended a more cautious approach for the elderly, suggesting less aggressive glucose lowering for people with complex health issues,” Lipska told Endocrine Today. “The problem is that we haven’t put this into practice. Our study suggests that we used a one-size-fits-all approach, which might have put millions of older Americans at risk.” – by Amber Cox
For more information:
Kasia J. Lipska, MD, MHS, can be reached at kasia.lipska@yale.edu.
Disclosure: Lipska reports no relevant financial disclosures. One researcher reports financial ties with Johnson & Johnson and Medtronic.