Older diabetic patients often overprescribed
Physicians typically don’t reduce older diabetic patents’ medications, even when they experienced potentially dangerous low blood sugar levels, according to a new study.
Published online in the October 26 issue of the journal JAMA Internal Medicine, the study was led by Jeremy Sussman, MD, assistant professor of internal medicine at the University of Michigan in Ann Arbor and a primary care doctor at the Ann Arbor VA System.
"As people get older, the risks of overtreating become greater, and the benefits become shorter. We have to start emphasizing that more isn't always better," Dr Sussman told HealthDay.
Among older patients whose treatment resulted in very low levels of blood glucose (HbA1c) or blood pressure, 27% or fewer underwent deintensification, “representing a lost opportunity to reduce overtreatment,” Dr Sussman wrote. “Low HbA1c or BP values or low life expectancy had little association with deintensification events. Practice guidelines and performance measures should place more focus on reducing overtreatment through deintensification.”
Dr Sussman and colleagues reviewed the medical records of 211,667 patients older than age 70 years with diabetes mellitus who were receiving active treatment (defined as BP-lowering medications other than angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, or glucose-lowering medications other than metformin hydrochloride) from January 1 to December 31, 2012. The patient records were obtained from the U.S. Veterans Health Administration.
The researchers found that, out of 104,486 patients with BP levels that were not low, treatment in 15.1% was deintensified. Of 25,955 patients with moderately low BP levels, treatment in 16.0% was deintensified. Among 81,226 patients with very low BP levels, 18.8% underwent BP medication deintensification. Of patients with very low BP levels whose treatment was not deintensified, only 0.2% had a follow-up BP measurement that was elevated.
Of 23,769 patients with moderately low blood glucose levels, treatment in 20.9% was deintensified. Among 12,917 patients with very low HbA1c levels, 27% underwent medication deintensification. Of patients with very low blood glucose levels whose treatment was not deintensified, fewer than 0.8% had a follow-up HbA1cmeasurement that was elevated.
The risks of overtreating high blood pressure could result in a substantial increase in falls, confusion and drug interactions, Dr Sussman told HealthDay