Undertreating diabetes is still a problem, but experts say many older adults get too much treatment for the disease and that can lead to serious health problems.
Properly treating diabetes is imperative, but it turns out that some people are being overtreated.
And that could be doing more harm than good.
According to a study in the Journal of General Internal Medicine, patients and their doctors may want to consider reducing treatment to avoid hypoglycemia.
The condition can cause everything from dizzy spells to death.
Matthew Maciejewski, PhD, a Duke University professor, led a team that found that nearly 11 percent of people with diabetes on Medicare had seriously low blood sugar levels — suggesting they could be overtreated or experience deintensification.
Only 14 percent of those people cut down on blood sugar medications in the following six months.
The researchers looked at records from 78,792 Medicare participants over age 65 in 10 states.
Who’s most likely to be overtreated?
People over 75 who qualify for Medicare and Medicaid, due to their low incomes and serious disabilities.
In addition, people with more than six chronic conditions, who lived in urban areas, or who had frequent outpatient visits, were more likely to have deintensification.
Dr. Jeremy Sussman and Dr. Eve Kerr, both with the University of Michigan and co-authors of the study, said warning signs of overtreatment include having symptomatic, low blood sugar levels often.
They said low values of A1c as well as for hemoglobin A1c can be concerning.
Dr. Anil Makam, a professor at the University of Texas, said there’s no way to be sure if a person is being overtreated.
“For an older adult with other serious health problems, I would not recommend aggressive diabetes control because the benefits of that approach do not become evident until many years later, typically up to one to two decades,” Makam told Healthline. “Rather, I would recommend good control of their sugar level so that the patient doesn’t experience any symptoms that may arise from having high blood sugars.”
He said people can tell if they’re being overtreated if they have consistently low to normal blood sugar (less than 150) or if they have a few low readings (less than 70).
The hemoglobin A1c, which is an average of your blood sugar level for the past three months, is another way to tell if a person is overtreated. If that test is less than 6.5 percent, it presents the possibility of overtreatment.
People have individualized goals, so overtreatment levels need to vary among individuals.
“The most important thing is for patients to have a conversation with their doctor to figure out what is the right goal for them before changing or stopping any of their medications,” Makam advised.
Sussman and Kerr say that people of all ages can be overtreated, but there’s more of a concern in older people because they’re less likely to feel the effects of overtreatment.
They also are more likely to have severe side effects such as fainting or falling.
“Though the harms of overtreatment can happen at any time, the benefits of aggressively treating diabetes are less for older patients and the harms are greater,” they said.
Overtreatment isn’t the only concern when it comes to treating diabetes. Undertreatment can be just as dangerous, they noted.
Still, overtreatment of diabetes with medical therapy is an “epidemic that few talk about and one that is hidden from the public,” Makam said.
“A large reason for this is because the diabetes and endocrinology medical communities ignore harms of overtreatment and only focus on the benefits,” he added.
Treating those with high blood sugar has helped saved lives. But the medical community has extended this concept to much more modest ranges of blood sugar elevation, where the benefits can be quite small and are mostly known as “surrogate benefits.” These include improvements in laboratory tests, nerve conduction tests, or retinal eye exams, and aren’t perceptible until at least one to two decades.
Those don’t necessarily help people live longer, Makam said.
“For younger healthier patients, we should strive for more aggressive treatment. But for sicker and older patients, we should aim for ‘good enough’ control,” he said.
