One-size-fits-all approach can lead to over-treatment in older diabetes patients

January 12, 2015, Yale University
Credit: Darren Lewis/public domain

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.

Published in the Jan. 12 issue of JAMA Internal Medicine, the study found that many older 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 , 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 Kasia Lipska, M.D., 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 2000 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 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 who often have other health issues."

Explore further: Severe low blood sugar occurs often in patients with Type 2 diabetes

More information: JAMA Internal Medicine, Published online January 12, 2015. archinte.jamanetwork.com/artic … ainternmed.2014.7345

Related Stories

Severe low blood sugar occurs often in patients with Type 2 diabetes

July 30, 2013
Patients with diabetes who take certain types of medications to lower their blood sugar sometimes experience severe low blood sugar levels, whether or not their diabetes is poorly or well controlled, according to a new study ...

Long-acting insulin is safer, more effective for patients with type 1 diabetes

October 1, 2014
Long-acting insulin is safer and more effective than intermediate-acting insulin for patients with Type 1 diabetes, according to new research published in the BMJ.

Islet cell transplantation restores type 1 diabetics' blood sugar defense mechanisms

December 18, 2014
Type 1 diabetes (T1D) patients who have developed low blood sugar (hypoglycemia) as a complication of insulin treatments over time are able to regain normal internal recognition of the condition after receiving pancreatic ...

Insulin, other drugs may do more harm than good for some type 2 diabetes patients

June 30, 2014
For patients with type 2 diabetes – especially those over age 50 – the negative impact of side effects like weight gain and burdens like frequent insulin shots trumps the benefits of drugs, says a new study by the University ...

Metformin beats other type 2 diabetes drugs for first treatment: study

October 28, 2014
(HealthDay)—People newly diagnosed with type 2 diabetes who are initially given the drug metformin are less likely to eventually need other drugs to control their blood sugar, a new study suggests.

Diabetes debate: Triglycerides form in liver despite insulin resistance

January 5, 2015
Solving one of the great mysteries of type 2 diabetes, a team of Yale researchers found that triglycerides, a type of fat in the blood and liver, are produced in the liver independent of insulin action in the liver.

Recommended for you

A novel insulin accelerant

October 17, 2018
Insulin levels rise after eating a meal, signaling uptake of circulating glucose by skeletal muscle. In individuals with diabetes this process is often impaired—a condition known as insulin resistance.

Fat tissue may play a crucial role in the progression of diabetes, challenging long established notions

October 12, 2018
A new study by Australian researchers, out today, is challenging what we know about the causes of diabetes. The new research points to fat tissue as a source of disease, and widens our understanding beyond the traditional ...

Does breastfeeding hormone protect against type 2 diabetes?

October 12, 2018
(HealthDay)—The hormone prolactin—most commonly associated with breastfeeding—may play a role in reducing the risk of type 2 diabetes, a new study suggests.

Markers of dairy fat consumption linked to lower risk of type two diabetes

October 10, 2018
Higher levels of biomarkers of dairy fat consumption are associated with a lower risk of developing type 2 diabetes, according to new research published today in PLOS Medicine. The study, in more than 60,000 adults, was undertaken ...

Planned intermittent fasting may help reverse type 2 diabetes, suggest doctors

October 10, 2018
Planned intermittent fasting may help to reverse type 2 diabetes, suggest doctors writing in the journal BMJ Case Reports after three patients in their care, who did this, were able to cut out the need for insulin treatment ...

New discovery restores insulin cell function in type 2 diabetes

October 8, 2018
By blocking a protein, VDAC1, in the insulin-producing beta cells, it is possible to restore their normal function in case of type 2 diabetes. In preclinical experiments, the researchers behind a new study have also shown ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.