3.Aggressive Glycemic Control in Older Patients Could Be harmful

A new research in the Journal of General Internal Medicine suggests that Medicare recipients are more frequently over treated than under treated for diabetes and rarely have their regimens deintensified, leaving them at increased risk of potentially life-threatening complications. “Severe hypoglycemia, cardiovascular events, cognitive impairment, fractures, and death associated with overtreatment of diabetes can happen at any time,” says Dr. Maciejewski and colleagues. Medicare claims data from 10 states in USA(1/1/2011–6/30/2011) were analysed.

The results were compiled by a team of researchers from Duke University, the University of Michigan and the VA hospitals in Durham, North Carolina and Ann Arbor, Michigan. Of 78,792 Medicare recipients with diabetes, 8,560 (10.9%) had very low blood sugar levels that suggested they were potentially over treated. Overtreatment of diabetes was more common among patients over 75 years of age and those who have low incomes or serious disability (13.4%) that qualified them for both Medicare and Medicaid (p < 0.001). Those who lived in urban areas or were of Hispanic origin were less likely to be over treated (p = 0.009). Therapy was deintensified for 14% of overtreated patients with diabetes. Patients who had six or more chronic conditions, or who lived in urban areas or had frequent outpatient visits, were more likely to get a deintensification of diabetes therapy.

Several major studies, as well as new clinical guidelines for diabetes management, have recommended relaxing glycemic-control in older adults with multiple chronic conditions, limited life expectancy, diabetic complications, or functional impairment. An effective treatment of diabetes requires individualized treatment for the patients. This study helps to identify those who may benefit from a more intensive treatment as well as those who may need less medication. “By focusing at both the overtreatment and undertreatment ends of the diabetes quality spectrum, we can best begin to truly improve the quality of diabetes care, ensuring that patients get needed care while avoiding unnecessary potential harm.” Sussman and his colleagues say.

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