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Wednesday, January 14, 2015, Magh 1, 1421, Robiul Awal 22, 1436 Hijr

Are some older patients being overtreated for diabetes?
Published : Wednesday, 14 January, 2015,  Time : 12:00 AM,  View Count : 13

James McIntosh
Diabetes frequently affects adults over 65. However, the best way for this age group to manage their glucose levels has been poorly defined by experts. New research now suggests that a substantial number of older adults with diabetes are being overtreated for the disease.
The study, published in JAMA Internal Medicine, examined the glycemic control of older patients with diabetes - some with very complex and poor health - in order to assess possible overtreatment of the metabolic disorder.
For younger, healthier adults with diabetes, the American Diabetes Association (ADA) suggests that blood sugar should be controlled to achieve a haemoglobin A1c level of less than 7 per cent. In contrast, the American Association of Clinical Endocrinologists (AACE) recommends a level below 6.5 per cent.
"However, older persons, particularly those with complex medical problems, may derive less benefit from intensive strategies to lower glucose levels," write the authors, "and are more susceptible to hypoglycaemia and its consequences compared with younger, healthier persons."
Hypoglycaemia, whereby levels of glucose in the blood become lower than normal, is the most common complication of diabetes in older adults and can lead to emergency hospitalizations. Nearly one-fourth of adverse drug events leading to emergency hospitalizations in older adults are attributed to hypoglycaemia.
The study was conducted by Dr Kasia Lipska of the Yale School of Medicine, New Haven, CT, and co-authors. The team analyzed data for 1,288 adults aged 65 and over.
Participants were separated into three groups according to their state of health, which the authors defined as:
"Those who are relatively healthy, those with complex medical histories for whom self-care may be difficult and those with a very significant comorbid illness and functional impairments, many of whom may have limited life expectancy."
Each participant had also previously been diagnosed with diabetes. Of the participants, 50.7 per cent were relatively healthy, 28.1 per cent had complex/intermediate health and 21.2 per cent had very complex/poor health.
In total, 61.5 per cent of the participants had tight glycemic control - a haemoglobin A1c level of less than 7 per cent - and this ratio of patients did not vary across the different health status groups.
Specifically, 62.8 per cent of the relatively healthy, 63 per cent of those with complex/intermediate health and 56.4 per cent of those with very complex/poor health had a haemoglobin A1c level that was lower than 7 per cent.
Of these participants, 54.9 per cent had their diabetes treated with either insulin or sulfonylureas. Again, this ratio of patients did not vary across the different health status groups.
The authors write that their findings show nearly two-thirds of older adults with diabetes and complex/intermediate or very complex/poor health attained tight glycemic control. ?Medical News Today 

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