Very tight blood glucose control can pose problems without benefits, researchers say
MONDAY, Jan. 12, 2015 (HealthDay News) — Many older people with diabetes may be exposed to potential harm because doctors are trying to keep overly tight control of their blood glucose levels, according to research published online Jan. 12 in JAMA Internal Medicine.
Kasia Lipska, M.D., an assistant professor of endocrinology at the Yale University School of Medicine in New Haven, Conn., and colleagues analyzed 2001 to 2010 data on 1,288 diabetes patients 65 and older from a U.S. survey. The patients were divided into three groups based on their health status: About half (50.7 percent) were considered relatively healthy despite their diabetes; 28.1 percent had complex/intermediate health, in that they also suffered from three or more other chronic conditions or had difficulty performing some basic daily activities; and 21.2 percent had very complex/poor health, and were either dependent on dialysis or struggling with activities of daily living.
Overall, 61.5 percent of all these patients had achieved tight blood glucose control. The proportion of patients with hemoglobin A1c <7 percent did not differ across health status categories: 62.8 percent were relatively healthy, 63.0 percent had complex/intermediate health, and 56.4 percent had very complex/poor health (P = 0.26). Little more than half (54.9 percent) of them had achieved this control by relying on insulin or sulfonylureas — medications that place them at greater risk of hypoglycemia, the researchers said.
Despite this aggressive treatment, the proportions of older patients with diabetes in good and poor health did not significantly change during the 10-year study period, calling into question whether doctors are overtreating these patients to no real benefit, Lipska told HealthDay. “I don’t think we should be using insulin or sulfonylureas in older patients,” she said. “This study shows that with people in poorer health, we’re treating them aggressively with these drugs, and it makes no difference.”
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