Older Adults May Be Harmed By Over Aggressive Glucose Control

Though over-aggressive glucose control may harm older individuals by causing low blood sugar, dizziness, and falls, a recent study finds the practice is still common.

The study, published in the Journal of General Internal Medicine revealed that nearly 11 percent of Medicare participants with diabetes had extremely low glucose levels, yet only 14 percent of them had their diabetes medication adjusted over the next six months.

People most likely to be over-treated were those above age 75, and those qualifying for Medicare and Medicaid owed to low incomes, or disability. Those over 75 were also less likely to have their diabetes treatment de-intensified.

Patients less often over-treated tended to live in urban areas, or were of Hispanic origin. Individuals with more than six chronic illnesses, or living in urban areas, or with frequent outpatient visits were the most likely to have their diabetes treatment de-intensified.

For those in their 70s and above having hypoglycemia, or low blood sugar increases the likelihood of dizzy spells and subsequent falls. Some of these individuals might fare better by maintaining slightly higher glucose levels. Patients with A1C readings below 6.5, for instance, could have their glucose medication dosage decreased, lowering their risk for hypoglycemia.

Though tight glucose control prevents or inhibits diabetes complications, patient needs change over time. People 70 and older may at some point be at such high risk for hypoglycemia and falls that short-term safety becomes a primary consideration.

“The oldest Medicare beneficiaries are the least likely to benefit from tight glycemic control and most likely to be harmed, so it is troubling that they were more likely to be over-treated and less likely to have their medication regimens de-intensified,” said researcher Dr. Jeremy Sussman, a member of the VA Center for Clinical Management Research and the University of Michigan Institute for Healthcare Policy and Innovation.

“By focusing on both over-treatment and under-treatment ends of the diabetes quality spectrum, we can best begin to improve the quality of diabetes care in all respects, ensuring that patients get needed care while avoiding unnecessary potential harm.”

Source: Science Daily
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