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Senior Diabetic Patients May Be Overtreated

Aggressively controlling blood sugar in older diabetics may actually lead to over-treatment and hypoglycemia (low blood sugar), researchers say.

Investigators from Yale University School of Medicine published their findings in JAMA Internal Medicine.

The researchers found that many diabetics 65 years and older got aggressive treatment regardless of their health status and blood sugar levels. In this age group, overtreatment could lead to low blood sugar, which can cause confusion, coma and even death.

“We treat diabetes to prevent complications of the disease by lowering blood sugar levels, but the problem with aggressively lowering blood sugars — to a hemoglobin A1c below 7% — in older people is that it is uncertain whether this approach will result in a benefit, and it could, in fact, cause greater harm,” said lead author Dr. Kasia Lipska, assistant professor of internal medicine at Yale School of Medicine. “Our study suggests that we have a one-size-fits-all approach despite questionable benefits and known risks. We have been potentially over-treated a substantial proportion of the population.”

For their analysis, Lipska and her colleagues looked at the health records of 1,288 diabetic patients age 65 and older from the National Health and Nutrition Examination Survey (NHANES). Specifically, the team studied glycemic control levels recorded between 2000 and 2010.

“We should use an individualized therapy approach when treating older diabetes patients,” said Lipska. “Older patients who are relatively healthy may benefit if they are treated in a similar way to younger diabetes patients, but this approach might not work in older patients who often have other health issues.”

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