Older patients are not the same as younger patients. You’d think this was obvious, yet doctors often use a one-size-fits-all approach to prescribing treatment that can put their older patients at risk.
The latest example of this: another study showing that patients 65 or older with diabetes may be overtreated by doctors who too aggressively try to control blood sugar levels, regardless of their patients’ other health problems.
The new study, by Yale researchers, analyzed a decade of data on 1,288 diabetes patients age 65-plus, from a federal health survey. Although the patients ranged from being relatively healthy to being in poor health with multiple problems, there was little difference in the proportion given insulin and sulfonylurea drugs to tamp down their blood sugar to the same low level.
This can put older patients at risk for hypoglycemia — a dangerous reaction to low blood sugar that can cause confusion, rapid heartbeat, vision problems and loss of consciousness, according to lead study author Kasia Lipska, M.D., assistant professor of endocrinology at the Yale School of Medicine.
There’s also little evidence that aggressively lowering blood sugars in older people to the standard target — hemoglobin A1C below 7 percent — provides any benefit, “and it could, in fact, cause greater harm,” she said in a statement.
“Our study suggests that we have a one-size-fits-all approach despite questionable benefits and known risks. We have been potentially over-treating a substantial proportion of the population,” Lipska said. The study was published Jan. 12 in the journal JAMA Internal Medicine.
This is not the first time researchers have warned about overtreating older patients with diabetes.
A study published last year in JAMA Internal Medicine by researchers with the Department of Veterans Affairs reached similar conclusions, the New York Times reported. Researchers wrote that the medications given to patients age 65-plus to control blood sugar were “the second most common medications associated with emergency department visits or hospitalizations and adverse drug events.”
A 2011 commentary in the Journal of the American Medical Association also pointed out the potential harm in using the same criteria for treating an 85-year-old as you would a 40-year-old. “Let’s be a bit more balanced,” Sei J. Lee, a geriatrician at the San Francisco VA Medical Center, told Times columnist Paula Span. “In the frail elderly, trying to get to near-normal blood sugar levels doesn’t make sense.”
And overtreatment is not a problem just for those with diabetes.
Researchers have raised similar questions about risks from overtreatment of older patients for other conditions, including an increased risk of fracture for those given thyroid hormones; higher complication rates from overtreatment for prostate cancer; higher death rates from carotid artery stents; and quality-of-life issues and higher complications from unneeded surgery for low-risk skin cancer.
As Lipska told Businessweek, it’s much easier for doctors to aim for the same goal for everyone than to tailor treatment to the individual. “When the goals are not the same for everyone, it requires a longer discussion, a more complicated risk-benefit analysis,” she says. “It’s more complicated, but I think it’s better care.”
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