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Intensive Treatment of Glucose Levels Can Lead to Serious Complications

With a more-is-better mindset common in society, frequent commercials encouraging checks of glycated hemoglobin (HbA1C) levels, and ads for new diabetes medications to lower HbA1C in adults with Type 2 diabetes, Mayo Clinic researchers were not too surprised to find overtesting occurring.

Beyond overtesting, however, such focus on HbA1C levels can lead to serious harms for patients, reports the research team, especially as more diabetes medications are needed to keep HbA1C within desired targets. This is particularly important for older patients with other medical conditions, they report in a study published online on June 6th 2016 in JAMA Internal Medicine.

A release from the Mayo Clinic quotes Rozalina McCoy, M.D., a Mayo Clinic primary care physician and endocrinologist, and lead author of the study, as saying, “At first, we were surprised to find how much overtesting for HbA1C is occurring among adults of all ages with Type 2 diabetes who were already well-controlled. But, then, we realized that not only were patients being tested frequently, they were also being treated with more medications than we would expect considering how low their HbA1C already was. So, this led us to do this study — to see how frequently patients are treated so intensively that they may be overtreated and what that does to their risk of hypoglycemia.”

“In this study, we found that, particularly among older patients and patients with serious chronic conditions, intensive treatment nearly doubled the risk of severe hypoglycemia requiring medical attention, including hospitalization,” says Dr. McCoy.

Hypoglycemia is a serious potential complication of diabetes treatment. It worsens quality of life and has been associated with cardiovascular events, dementia and death.

Most professional societies recommend targeting HbA1C levels less than 6.5 or 7 percent, with individualized treatment targets based on patient age, other medical conditions, and risk of hypoglycemia with therapy.

“Treating patients to very low HbA1c levels is not likely to improve their health, especially not in the short term, but can cause serious harms, such as hypoglycemia,” says Dr. McCoy.

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