Some Diabetes Patients Are Over-Treated, Study Finds

By Jane Farrell

Although diabetes is one of the most serious health problems we face, a new study found that 11 percent of patients are actually over-treated.

The study focused on blood sugar medication. Elevated blood sugar can harm everything from the heart and kidneys to eyes and feet.

But stopping, or cutting back on, such drugs may help patients even more than the medication itself.

In some older people, such “deintensification” of diabetes treatment may be the safer route, because of the risks of falls and other issues that come with too-low blood sugar.

A new study in the Journal of General Internal Medicine suggests more doctors and such patients should work together to dial back diabetes treatment.

Almost 11 percent of Medicare participants with diabetes had very low blood sugar levels that suggested they were being over-treated, the new study finds. But only 14 percent of these patients had a reduction in blood sugar medication refills in the next six months.

Patients over age 75, and those who qualified for both Medicare and Medicaid because of low incomes or serious disability, were most likely to be over-treated. Those who lived in urban areas or were of Hispanic origin were less likely to be over-treated.

Patients over age 75 were less likely than others to have their treatment dialed back, as measured by prescription doses and refills.

But patients who had more than six chronic conditions, or who lived in urban areas or had frequent outpatient visits, were more likely to experience a deintensification.

The results were compiled by a team of researchers from Duke University, the University of Michigan and the VA hospitals in Durham, North Carolina and Ann Arbor, Michigan. They studied detailed records from 78,792 Medicare participants over age 65 in ten states, all of whom had diabetes.

The authors, led by Duke/Durham researcher Matthew Maciejewski, Ph.D., warn against a one-size-fits-all approach when treating diabetes in older patients. They call for greater personalized care that takes account of the risks and benefits that such treatment holds for individual patients.

Jeremy Sussman, M.D., M.S., a co-author of the new study and U-M/VA researcher, suggests that older patients with diabetes – and the adult children who often assist with their care – should talk to their care teams about whether de-intensification is right for them.

In people in their 70s and older, very low blood sugar levels – called hypoglycemia — can actually raise the risk of dizzy spells, confusion, falls and even death.

In recent years, experts have started to suggest that doctors ease up on how aggressively they treat such patients for high blood pressure or diabetes — especially if they have other conditions that limit their life expectancy.

It can be hard for an older person to recognize the signs of too-low blood sugar, such as confusion and combativeness, or of too-low blood pressure, such as dizziness.

Meanwhile, keeping up with taking multiple medications, and checking blood sugar daily or even more often, can be a struggle for the oldest patients. De-intensifying their treatment can often be a relief.

The VA system is actively trying to encourage de-intensification of blood sugar-reducing treatment in its oldest patients nationwide. The U-M/Ann Arbor VA team, led by Eve Kerr, M.D., M.S., is studying the effects of that effort.