Are Older Adults Over-Treated for Diabetes?

Controlling blood sugar may be the goal for diabetes patients, but a new study from Yale University finds that doing so with a one-size-fits-all approach could harm older patients with multiple medical conditions.

Treating diabetes per se isn’t the problem, said Dr. Kasia Lipska, an assistant professor of internal medicine at the Yale School of Medicine. The problem is many patients and doctors do not carefully customize the treatment, which can lead to over-treatment and pose additional health risks.

Lowering blood sugar to reach a hemoglobin A1c reading below 7 percent is a common goal in diabetes treatment, but not all people need to reduce their blood sugar to that exact level.

Specifically, using insulin and sulfonylurea drugs to lower blood sugar can lead to hypoglycemia, or low blood sugar, which poses its own medical threat.

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“For many patients it seems like we’ve gone a little too far,” Lipska told Healthline. In many cases, physicians are using a one-size-fits-all approach, despite “questionable benefits and known risks.”

“We have been potentially over-treating a substantial proportion of the population,” she added.

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Lipska and her colleagues evaluated the National Health and Nutrition Examination Survey (NHANES) records of 1,288 diabetes patients older than 65. They looked at patients’ blood sugar control levels between 2001 and 2010. Researchers split patients into three groups: Those who were relatively healthy, those who had poor health, and those with intermediate health.

They found that about 62 percent of patients had A1c measurements of less than 7 percent, which didn’t vary regardless of which group they were in. Of these patients, 55 percent took insulin or sulfonylureas medications to treat the disease.

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“Diabetes is not about finding one particular target and treating everyone to an A1c below 7 percent,” Lipska said.

Discussing the treatment goal — as well as risks and benefits of specific medications — is key for all diabetes patients and their doctors. Lipska said many patients with multiple conditions are often taking other medications, which can complicate their condition.

“We should use an individualized therapy approach when treating older diabetes patients,” 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.”

She emphasized that patients shouldn’t abandon treatment altogether, but should make sure their doctors have tailored the treatment to fit them.

“It appears many older people have been treated in a way that may not result in a benefit and may result in greater harm,” Lipska said.

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