Yale. US: Diabetes treatments have saved many lives, but in older patients with
multiple medical conditions, aggressively controlling blood sugar with
insulin and sulfonylurea drugs, could lead to over-treatment and
hypoglycemia (low blood sugar), according to new research by Yale School
of Medicine researchers. More about diabetes type 1 / type 2
Published in the Jan. 12 issue of JAMA
Internal Medicine, the study found that many older diabetes patients
received aggressive treatment for their disease regardless of their
health status and blood sugar levels. In patients with diabetes age 65
and older, this could result in hypoglycemia, a serious health threat,
which can lead to confusion, coma, and even death.
“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% — is that it is uncertain
whether this approach provides a benefit, and it could, in fact, cause
greater harm,” said lead author Dr. Kasia Lipska,
assistant professor of internal medicine at Yale School of Medicine.
“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.”
Lipska
and her colleagues conducted a cross-sectional study that analyzed the
health records of 1,288 patients age 65 and older with diabetes from the
National Health and Nutrition Examination Survey (NHANES). The team
analyzed glycemic control levels recorded in NHANES between 2001 and
2010.
Patients were divided into three groups based on their
health status: very complex/poor, complex/intermediate, and relatively
healthy. Blood sugar was considered controlled if it fell below 7%.
About 62% of the patients had blood sugar levels less than 7% and this
did not differ across health status. Of those patients, 55% were treated
with either insulin or sulfonylureas medications.
“We should use
an individualized therapy approach when treating older diabetes
patients,” said Lipska. “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.”
Other authors on the study included Dr.
Joseph S. Ross, Yinghui Miao, Nilay D. Shah, Dr. Sei J. Lee, and Dr.
Michael A. Steinman.
The study was supported in part by the
following: The Pepper Center Career Development Award, the National
Institute on Aging, the Yale Clinical and Translational Science Award
(CTSA) grant from the National Center for Advancing Translational
Sciences (NCATS) at the National Institutes of Health, and the American
Federation for Aging Research through the Paul B. Beeson Career
Development Program.
Citation: JAMA Internal Medicine