12 Jan Diabetes May Be Frequently Overtreated In Older Adults

MedicalResearch.com Interview with:
Kasia Joanna Lipska MD, MHS
Assistant Professor of Medicine (Endocrinology)
Yale School of Medicine
New Haven, CT 06520-8020

Medical Research: What is the background for this study? What are the main findings?

Dr. Lipska: Diabetes is common and affects about 1 in 4 older adults (65 years or more). For younger adults with diabetes, most guidelines suggest lowering blood sugar levels to a hemoglobin A1c below 7%. However, in older patients, especially those with complex medical problems, the benefits of this strategy are unclear. What’s more, this strategy can cause harm. Aiming for a hemoglobin A1c below seven increases the risk for hypoglycemia. And older adults are especially susceptible to this risk. As a result, many guidelines suggest that treatment should be more cautious for these vulnerable elders and that aiming for “tight” blood sugar control may not be worth the risk.

Medical Research: What are the main findings?

Dr. Lipska: We looked at diabetes treatment of older adults using nationally representative data from 2001 to 2010. We found that 62% of older adults with diabetes had a hemoglobin A1c below 7%. But what’s really striking is that this proportion was similar for patients who were relatively healthy, for those with intermediate health, and for those with poor health. What’s more, the use of insulin or sulfonylureas (drugs that increase the risk for hypoglycemia) was common and similar across these groups.

Medical Research: What should clinicians and patients take away from your report?

Dr. Lipska: These findings suggest that many older adults with diabetes were potentially over-treated. In other words, they reached hemoglobin A1c targets below 7% despite questionable benefits and potential harms.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Lipska: Future research needs to help us better understand the benefits and harms of treatment among people with complex health problems. The goal is to be able to communicate these risks and benefits of treatment so that each patient can make an informed decision.

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Last Updated on January 12, 2015 by Marie Benz MD FAAD