Majority of Older Adults With Diabetes Likely Being Overtreated

Older adults with diabetes are being overtreated for their condition, leading to harmful outcomes, according to a study published in JAMA Internal Medicine.

Researchers found that nearly two-thirds of older adults with diabetes with complex/intermediate or very complex/poor health status reached tight glycemic targets. Most of them were treated with insulin or sulfonylureas, which can lead to severe hypoglycemia. They analyzed data on 1288 adults aged 65 years and older from the National Health and Nutrition Examination Survey from 2001 to 2010.

“Using a nationally representative sample of U.S. adults, we showed that nearly two-thirds of older adults with diabetes who have complex/intermediate or very complex/poor health attained tight glycemic control,” the authors explained. “These vulnerable adults are unlikely to experience the benefits of intensive glycemic control and instead are likely to experience harms from treatment, such as hypoglycemia and other adverse effects.”

While tight glycemic control may be appropriate for relatively health patients with long life expectancies, because it increases the risk of hypoglycemia, which is associated with increased mortality, cardiovascular disease, falls and accidence, dementia, intensive strategies may be more harmful than beneficial for older, sicker patients.

The authors conservatively estimated that approximately 1 million older adults with diabetes attained tight glycemic control despite complex/intermediate or very complex/poor health and where, thus, overtreated. The data had incomplete information on all comorbidities, so it is likely that they underestimated the amount of adults who are potentially overtreated.

However, the authors were not able to determine whether potential overtreatment resulted in direct harm to the patients as achieved HbA1C level is a poor predictor of self-reported serious hypoglycemia, they wrote.

“Recognition of both the harms and benefits of glycemic control is critical for patients and physicians and other health care professionals to make informed decisions about glucose-lowering treatment,” the authors concluded.