Are Older Adults With Type 2 Diabetes Overtreated?

A study published in Diabetes, Obesity & Metabolism found 38.8 percent of older adults in primary care with type 2 diabetes and a target stringent glycated hemoglobin (HbA1c) of greater than 7 percent were "overtreated," comprising nearly 20 percent of all older persons, reports MedPage Today . Those with a target HbA1c of greater than 7 percent had a significantly higher rate of complications. "The beneficial effects of stringent glycated hemoglobin (HbA1c) goals in older adults with long-existing type 2 diabetes and vascular complications are not proven," the authors note. They also report "the risk of harm associated with an HbA1c target lower than the conventional 7 percent (53 mmol/mol) seems to outweigh the possible benefits for adults aged 70 years or older." The older adults considered overtreated were more frequently prescribed metformin and sulfonylureas. About 17 percent of this cohort noted a hypoglycemic event during the observation period, which led to four falls and one emergency department visit. "Care professionals should abandon the 'one size fits all' approach and realize the possible benefits of de-intensifying blood glucose-lowering treatment," the researchers recommend. "To prevent overtreatment, a lower HbA1c limit in the guidelines might be helpful. Diabetes quality indicators should not be based on population-based mean values, because means will overlook under- and overtreatment completely."