Durham, NC—More than one in 10 Medicare patients with diabetes had very low blood sugar, suggesting possible overtreatment, according to a new study. Yet very few of them reduced their refills of glucose-lowering medications over the next 6 months.
The article in the Journal of General Internal Medicine urges deintensification of diabetes treatment in those patients to avoid falls and other risks of too-low blood sugar.
Researchers from Veterans Affairs (VA) Medical Centers in Durham, North Carolina, and Ann Arbor, Michigan, as well as Duke University and the University of Michigan, found that nearly 11% of Medicare beneficiaries with type 2 diabetes had very low blood sugar, defined as hemoglobin A1C under 6.5%. Yet based on pharmacy information, only 14% percent of them appeared to reduce their diabetes medication.
Included in the study were detailed records from 78,792 Medicare participants diagnosed with type 2 diabetes in 10 states.
Most likely to be overtreated were patients aged more than 75 years and those who qualified for both Medicare and Medicaid because of low incomes or serious disability.
Less likely to be overtreated were patients who lived in urban areas or were of Hispanic origin.
In addition, patients aged more 75 years also were less likely to have their treatment de-intensified, study authors note. At the same time, patients who had more than six chronic conditions, or who lived in urban areas, or had frequent outpatient visits were more likely to undergo a reduction in glucose-lowering drugs.
The authors caution against a “one-size-fits-all” approach when treating diabetes in older patients and urge more personalized care.
“Every guideline for physicians has detailed guidance for prescribing and stepping up or adding drugs to control these risk factors, and somewhere toward the end it says ‘personalize treatment for older people’,” explained co-author Jeremy Sussman, MD, MSc, a University of Michigan assistant professor of general internal medicine and VA Ann Arbor researcher. “But nowhere do they say actually stop medication in the oldest patients to avoid hypoglycemia or too-low blood pressure.”
A previous study by Sussman and colleagues showed that only one in four of nearly 400,000 older patients in the VA system had their dosage changed, despite having glucose levels low enough to justify that. In fact, patients with the lowest readings or the fewest years left to live were only slightly more likely to undergo type 2 diabetes treatment deintensification.
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