Are Seniors With Diabetes Overtreated?

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Very tight blood sugar control can pose problems without benefits, study says

WebMD News from HealthDay
By Dennis Thompson
HealthDay Reporter
MONDAY, Jan. 12, 2015 (HealthDay News) -- Many older people with diabetes may be exposed to potential harm because doctors are trying to keep overly tight control of their blood sugar levels, a new study argues.
Researchers found that nearly two-thirds of older diabetics who are in poor health have been placed on a diabetes management regimen that strictly controls their blood sugar, aiming at a targeted hemoglobin A1C level of less than 7 percent.
But these patients are achieving that goal through the use of medications that place them at greater risk of hypoglycemia, a reaction to overly low blood sugar that can cause abnormal heart rhythms, and dizziness or loss of consciousness, the researchers said.
Further, tight diabetes control did not appear to benefit the patients, the researchers report Jan. 12 in JAMA Internal Medicine. The percentage of seniors with diabetes in poor health did not change in more than a decade, even though many had undergone years of aggressive blood sugar treatment.
"There is increasing evidence that tight blood sugar control can cause harm in older people, and older people are more susceptible to hypoglycemia," said lead author Dr. Kasia Lipska, an assistant professor of endocrinology at Yale University School of Medicine. "More than half of these patients were being treated with medications that are unlikely to benefit them and can cause problems."
Diabetes is common among people 65 and older. But doctors have struggled to come up with the best way to manage diabetes in seniors alongside the other health problems they typically have, researchers said in background information with the study.
For younger and healthier adults, the American Diabetes Association has recommended therapy that aims at a hemoglobin A1C level of lower than 7 percent, while the American Association of Clinical Endocrinologists recommends a target of lower than 6.5 percent, the authors noted. The A1C test provides a picture of your average blood sugar levels for the past two to three months.
By tightly controlling blood sugar levels, doctors hope to stave off the complications of diabetes, including organ damage, blindness, and amputations due to nerve damage in the limbs.