FROM JAMA INTERNAL MEDICINE
Most older patients with diabetes who had complex or poor health status and limited life expectancy were still given insulin or sulfonylureas to achieve tight glycemic control, even though such intensive treatment likely causes more harm than good in this patient population, according to a report published online Jan. 12 in JAMA Internal Medicine.
Diabetes is highly prevalent among Americans aged 65 years and older, and tight glycemic control achieved through medication use poses significant threats to them – chiefly, hypoglycemia –without imparting the benefits seen in younger, healthier patients, said Dr. Kasia J. Lipska of Yale University, New Haven, Conn., and her associates. Hypoglycemia is associated with increased mortality, cardiovascular disease, falls and accidents, dementia, and a poor health-related quality of life in older adults.
To examine such overtreatment, the investigators analyzed National Health and Nutrition Examination Survey data during a 10-year period. They focused on 1,288 participants aged 65 years and older (mean age, 73 years) whose hemoglobin A1c levels indicated glycemic control that was categorized as poor (9% or higher), moderate (7%-8.9%), or tight (<7%); the latter category included those patients with very tight glycemic control (<6.5%).
Dr. Lipska and her associates found that 62% of the sample, representing nearly 4 million older Americans, had tight glycemic control, including 42%, representing 2.6 million older Americans, who had very tight glycemic control.
Most of those patients were taking insulin or sulfonylureas. That included the majority of patients who had complex health profiles or poor health because of such coexisting conditions as arthritis, heart failure, lung disease, chronic kidney disease, coronary heart disease, stroke, urinary incontinence, and functional impairments.
“Given incomplete information on all comorbidities in our study, it is likely that we underestimated the complexity of health status, and thus, true estimates of adults who are potentially overtreated may be even higher,” the investigators said (JAMA Intern. Med. 2015 Jan. 12 [doi:10.1001/jamainternmed.2014.7345]).
“Recognition of both the harms and the benefits of glycemic control is critical for patients and physicians and other health care professionals to make informed decisions about glucose-lowering treatment,” the investigators added.
A Pepper Center Career Development Award, the National Institute on Aging, the Yale Center for Investigation, the American Federation for Aging Research, the Paul B. Beeson Career Development Program, and the National Institutes of Health funded the study. Dr. Lipska reported having no financial conflicts. Her associates reported ties to Medtronic, Johnson & Johnson, and FAIR Health.