In older diabetic adults who have multiple comorbidities or poor functionality, the harms of intensive glycemic control likely exceed the benefits, a new study concludes. Many older patients who achieved HbA1C levels of less than 7% were treated with insulin or sulfonylureas--medications that may lead to severe hypoglycemia.
According to other research, glucose-lowering drugs were involved in 25% of emergency hospitalizations in older people, nearly all for low blood sugar. Another study showed that a significant percentage of adults over age 77 died within 30 days of their hospital admission with hypoglycemia.
For the current study, Kasia J. Lipska, MD, assistant professor of medicine and diabetes specialist at Yale School of Medicine, and colleagues examined glycemic control in 1,288 adults older than 65 with diabetes. The investigators categorized patients by their health status: 50.7% were relatively healthy despite diabetes, 28.1% had complex/intermediate health with three or more chronic conditions or difficulty with daily activities, and 21.2% had very complex/poor health with dialysis dependence or poor functionality.
According to results published online by JAMA Internal Medicine, 61.5% attained an HbA1c level of less than 7%. Similar proportions were found across health status categories.
Among senior patients with HbA1c levels below 7%, 54.9% were treated with insulin or sulfonylureas. Again, roughly the same proportions were found among the health status groupings.
In the years between 2001 and 2010, there appeared to be no change in glucose management for these older patients with diabetes. The same proportion of older adults had HbA1c levels less than 7%. Tight glucose control was maintained in both patients with complex/intermediate or very complex/poor health and those treated with insulin or sulfonylureas with complex health problems.
Achieving HbA1c levels less than 7%, long drilled into the mindsets of physicians, may not be an appropriate target for these senior diabetic patients, experts suggest.
Many older people with diabetes who have compromised health have been kept on intensive treatment regimens, which increases the risk of hypoglycemia, researchers reported.
“The risks appear to outweigh the benefits,” said Kasia Lipska, MD MHS, an assistant professor of medicine and diabetes specialist at Yale School of Medicine, lead author of a study published online by JAMA Internal Medicine. “We know that older people are at special risk.”
The JAMA Internal Medicine study echoes concerns raised last month in a MedPage Today/Journal Sentinel investigation of diabetes drugs approved by the U.S. Food and Drug Administration over the last decade.