Researchers from the Yale University School of Medicine, Yale-New Haven Hospital, San Francisco Veterans Affairs Medical Center, Mayo Clinic and University of California have found that older patients may be receiving overtreatment when a one-size-fits-all approach is being followed in addressing diabetes.
In a study published in JAMA Internal Medicine, researchers noted that a lot of older diabetes patients are being given aggressive treatment without regard for their current blood sugar levels and health status. This creates higher risks of hypoglycemia in patients above 65 years old, potentially leading to coma, confusion and sometimes even death.
"The problem with aggressively lowering blood sugars in older people is that it is uncertain whether this approach provides a benefit, and it could, in fact, cause greater harm," explained Dr. Kasia Lipska, an internal medicine assistant professor from the Yale School of Medicine and lead author for the study, adding that their study suggests a one-size-fits-all approach is being followed despite the known risks and questionable benefits it brings.
Researchers conducted a study analyzing health records for 1,288 patients at least 65 years old and diagnosed with diabetes. The data for the study was collected from the National Health and Nutrition Examination Survey, specifically those recorded from 2001 to 2010.
Patients were categorized into three depending on the status of their health: relatively healthy, complex/intermediate and very complex/poor. If blood sugar levels fell to 7 percent, it was considered under control.
Around 62 percent of patients had levels of blood sugar lower than 7 percent and this was not affected by their health statuses. Of these patients, 55 percent were administered either sulfonylureas or insulin.
Lipska said that older patients in relatively good health may benefit when treated with methods similar to those used on younger diabetic patients but the same could not be said about those who have other known issues with their health. Individualized treatment is still the best way in addressing diabetes in older patients.
The study received support from the Paul B. Beeson Career Development Program, the National Institutes of Health (Yale Clinical and Translational Science Award), the National Institute on Aging and The Pepper Center Career Development Award.
Other authors include: Michael Steinman, M.D., Sei Lee, M.D., M.A.S., Nilay Shah, Ph.D., Yinghui Miao, M.P.H. and Joseph Ross, M.D.
In 2012, 11.2 million adults 65 years old and beyond had diabetes [pdf] in the United States. Out of that, 400,000 were new cases. Estimated total cost of dealing with diabetes for the year was set at $245 billion.
