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Overtreating Diabetes??

You may find a study just published in the Journal of the American Medical Association (JAMA) interesting. The article, entitled Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control, explores a subject that medical professionals struggle with frequently – when is the “cure” worse than the disease? In this case, the question becomes whether the risk of severe hypoglycemia (low blood sugar) outweighs the risk for diabetes complications in older adults.

Hypoglycemia is always a risk when diabetes is treated with any type of insulin, or with some oral medications that stimulate your pancreas to release more natural insulin. The technical classes of these oral drugs are sulfonylureas and meglitinides, but the brand names are too numerous to mention here. The main point is that it’s diabetes medications – not diabetes – that causes low blood glucose.

Hypoglycemia is a special concern because it can be extremely dangerous. The potential for hypoglycemia is an even greater concern in seniors, who may live alone, or have difficulty managing medications. Glucose-lowering medications (including insulin) are responsible for 25% of “adverse drug events” among seniors.

With type 2 diabetes, the other side of the risk calculation is the risk from diabetes complications, including heart attack, stroke, kidney failure and blindness. These risks are associated with poorly controlled blood glucose levels. But, these conditions develop over time – 10 years or more. For that reason, most medical professionals agree that using aggressive blood glucose management strategies may not be justified in older patients or in patients who have complex health issues likely to shorten their life anyway. In fact, the American Diabetes Association has backed off of its 7% “target” A1C for patients fitting this profile.

The study referenced above involved more than 1,000 subjects with an average age of 73, including seniors in good health as well as seniors who were very ill with “functional impairments”. And, while 60% of their study population had excellent A1C levels at or below 7%, more than half of those were being treated with hypoglycemic drugs to achieve this level of blood glucose control. The authors suggested that aggressive diabetes treatment carries too high a risk for many of these patients, and that doctors should consider the risk for hypoglycemia more closely when treating older patients.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.