There are almost 26 million people in the U.S. living with diabetes, and 90 to 95 percent of them have type 2 diabetes, formerly known as adult-onset diabetes. Upon being diagnosed with diabetes, it’s obvious that they should undergo a treatment plan that will reduce their blood sugar to a tolerable level. In doing so, they’re then able to prevent or delay the onset of complications, such as blindness and neuropathy. A new study, however, has found that treatment might not be for everyone, especially diabetic patients who are already reaching the end of their lives.
“For people with type 2 diabetes, the goal of managing blood sugar levels is to prevent associated diabetes complications, such as kidney, eye and heart disease, but it is essential to balance complication risks and treatment burdens when deciding how aggressively to treat blood sugars,” said lead author Dr. Sandeep Vijan, a professor of internal medicine at the University of Michigan Medical School, in a press release.
While there’s no doubt regarding the benefits of diabetes treatment, questions begin to arise when patients experience symptoms from low blood sugar, weight gain, or the hassle of dealing with frequent insulin shots, Vijan said. If getting treatment is putting too much of a burden on older patients, and thus reducing their quality of life, should they really be undergoing continuous treatment? Maybe not.
Although it’s difficult, diabetics can manage their blood glucose levels with a healthy diet and exercise. If they’re able to keep their blood sugar levels down — even with the help of meds at first — there is hardly a need for them to keep taking their meds, as long as they keep their glucose levels manageable. Taking this route may be riskier in terms of further diabetes progression and subsequent treatment costs, etc., but it could be the best route for people aged 75, or close to it. After all, it’s better to live managing diabetes closely, without complications, than to go through the trouble of obtaining drugs that have minimal effect while causing more depressing side effects.
Instead of trying to reach a so-called “glucose goal,” the researchers said that doctors should actually assess each patients’ risk for complications, based on their age and glucose levels. “Drugs that lower blood sugar levels are extremely beneficial in some patients but offer almost no benefit for others.
“These results have major implications for the millions of people who are currently being told that they need to increase medication in order to achieve their ‘glucose goal,’” said senior author of the study Dr. Rodney Hayward, a professor of medicine at the university’s medical school. “Current quality measures do not allow doctors and patients to make good decisions for each patient because they emphasize reaching targets instead of thinking of the risks and benefits of starting new medications based on individual circumstance.”
The harmful effects of diabetes treatment aren’t unique to older diabetics either. A 2007 study found that diabetics, ages 18 and up, not only reported a lower quality of life from diabetes complications but also from diabetes treatments. Those who were undergoing intensive glucose control — the kind addressed in Vijan’s study — reported the lowest levels of life quality.
Vijan and his colleagues hope that their findings can help shape future diabetes guidelines, similar to the way hypertension guidelines were changed last year in response to studies finding that risks outweighed benefits for certain blood pressure drugs.
Source: Vijan S, Hayward R, Sussman J. The effect of patients' risks and preferences on health gains with glucose lowering in type 2 diabetes: Patient preferences and outcomes of glycemic control. JAMA Internal Medicine. 2014.