Many Seniors May Be Overtreated for Diabetes, High Blood Pressure
Physicians may be concerned about malpractice claims or performance measure variables.
(HealthDay News) -- When it comes to treating seniors with diabetes, new research suggests that doctors often don't cut back on medications, even when treatment goals are surpassed. The findings were published online in JAMA Internal Medicine.
In one study, researchers reviewed U.S. Veterans Health Affairs records for 211,667 patients with diabetes between 2012 and 2015. All were aged 70 or older. The team found that when patients had very low HbA1c levels (less than 6%), 27% had their medicines decreased. And when blood pressure treatments lowered blood pressure levels to less than 120/65 mm Hg, 18.8% saw a reduction in their medications.
In a second study, researchers from the Ann Arbor Veterans Affairs Center for Clinical Management Research in Michigan surveyed a national sample of 594 physicians working in the U.S. Department of Veterans Affairs. One-third of doctors surveyed said they thought their patients could benefit from exceeding treatment guideline goals. Nearly one-quarter were concerned about a potential malpractice suit from reducing treatment. Nearly half were concerned that lowering medications for those who've exceeded the goals would lower their scores on performance measures, the researchers found. Another 20% were worried that patients would be upset if they reduced their medications.
"As people get older, the risks of overtreating become greater, and the benefits become shorter. We have to start emphasizing that more isn't always better," lead author of the first study Jeremy Sussman, M.D., an assistant professor of internal medicine at the University of Michigan in Ann Arbor and a primary care doctor at the Ann Arbor VA System, told HealthDay.
- Sussman JB, Kerr EA, Saini SD, et al. Rates of Deintensification of Blood Pressure and Glycemic Medication Treatment Based on Levels of Control and Life Expectancy in Older Patients With Diabetes Mellitus. JAMA Intern Med; doi:10.1001/jamainternmed.2015.5110.
- Caverly TJ, Fagerlin A, Zikmund-Fisher BJ, et al. Appropriate Prescribing for Patients With Diabetes at High Risk for Hypoglycemia. JAMA Intern Med; doi: 10.1001/jamainternmed.2015.5950.
- Mossello E. Targeting Vascular Risk Factors in Older Adults. JAMA Intern Med; doi: 10.1001/jamainternmed.2015.5941.