Friday , November 24 2017
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Too Much Medication for Elderly Diabetes Patients?

As patients become older, they become more vulnerable to the risk of side effects that are present with diabetic medications…. 

Older diabetes patients are often switched over to insulin and sulfonylurea drugs as they undergo intensive therapy to control glucose levels. The purpose of this cross-sectional study in patients receiving insulin and sulfonylureas was to identify a correlation in high-risk patients receiving intensive glycemic management and the risk of serious hypoglycemia. High doses of insulin or sulfonylureas can cause an older person’s blood glucose to dramatically decrease, enough to cause loss of consciousness and even death. Dosing older diabetic patients can be challenging because of chronic medical conditions and self-care challenges.

In a study conducted by the Department of Veterans Affairs, approximately 206,000 (31.5%) of the 652,378 patients who received insulin or sulfonylureas had significantly more aggressive treatment than the recommended diabetes guidelines. An intensive treatment was considered an HbA1c less than 7.0% in patients who were aged 75 years or older with impaired kidney functions, cognitive impairment, and other comorbid illness. In the 206,000 patients who received aggressive diabetic treatment, an average of 11.3% had a HbA1c value less than 6.0%, 28.6% less than 6.5%, and 50.0% less than 7.0%. Rates of overtreatment were 10.1% for HbA1c less than 6.0%, 25.2% for less than 6.5%, and 44.3% for less than 7.0%.

This study showed that a large number of elderly patients with diabetes are being over-treated. Despite diabetic guidelines for patients with comorbid conditions to have an HbA1c of 8-9%, doctors are still pushing below 7% HbA1c levels. Although bringing down blood sugar is important in treating diabetes, the risk of hypoglycemia can be more dangerous in the short-run when compared to hyperglycemia.

Practice Pearls:
  • Older diabetes patients are often switched over to insulin and sulfonylurea drugs as they undergo intensive therapy to control glycemic levels.
  • High doses of insulin or sulfonylureas can cause an older person’s blood glucose to dramatically decrease, enough to cause loss of consciousness and even death
  • A large number of elderly patients with diabetes are being over-treated despite diabetic guidelines for patients with comorbid conditions to have an HbA1c of 8-9%.

Andrews M, O’Malley P. Diabetes overtreatment in elderly individuals: risky business in need of better management. JAMA 2014;311(22):2326-2327.doi:10.1001/jama.2014.4563.