January 20, 2015

Are Older Adults Really Being Overtreated for Diabetes?

The people publishing studies in the Journal of the American Medical Association (JAMA) Internal Medicine seem determined to destroy healthcare for the elderly. The topic in the Endocrinology Advisor is titled “Older Adults May Be Overtreated for Diabetes.” To this, I am saying, in whose determination.

They do use the American Diabetes Association guidelines of course and state, “Despite the prevalence of diabetes in older people, optimal glucose levels are still poorly defined. Currently, the American Diabetes Association (ADA) and American Geriatrics Society (AGS) agree that glycemic targets should be higher for older patients with compromised health. I say that these “experts” have not done their homework and have very few studies available to justify their pronouncement.

They are claiming that most patients with diabetes aged 65 and older still maintain HbA1c levels of less than 7%. In older patients, there are limited benefits to such tight glycemic control, and they have a high risk for complications, such as hypoglycemia, with the use of some glucose-lowering medications.

Researchers wanted to determine if older adults with diabetes were potentially being overtreated for the condition.

The study included data from 1,288 patients aged 65 years and older with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2010. The patients were divided into three groups based on health status. 

The first group was considered as having very complex/poor health, where patients had difficulty with ≥2 integral daily tasks or dialysis dependence. The second group was categorized as complex/intermediate, where patients had difficulty with ≥2 integral daily tasks or had ≥3 chronic conditions. The third group was composed of relatively healthy participants if they did not fit the criteria for the other groups.

Tight glycemic control was considered an HbA1c level <7 i="">

Using these parameters, 21.2% had very complex/poor health, 28.1% had complex/intermediate health, and 50.7% were relatively healthy. Out of all the participants, 61.5% achieved tight glycemic control; this proportion did not significantly differ based on health status.

Of the patients with tight glycemic control, 54.9% were treated with either insulin or sulfonylureas; again, this proportion did not significantly differ based on health status.”

Now this study is more reasonable in the method used in placing people in the three groups, but one thing still bothers me. Why are not people being given an opportunity to express their opinion about their care? Everything seems to be determined for them and though not mentioned in the abstract, the three groups were determined by a one-size-fits-all determination.

Again, hypoglycemia and the fear of hypoglycemia by the researchers play a big role in the group they were placed in for the study. The other weakness of the study is about 55 percent of all groups were on insulin or sulfonylureas. Unknown is the medications that the other 45 percent were taking.

To my way of thinking, the study was done to provide information to discriminate against the elderly and not to find out if the elderly are capable of managing diabetes in what they determined was tight control of less than 7.0% for A1c.

The only time I could agree with the researchers would be if there was cognitive issues and they did not have a capable caregiver available.

For another interesting read, this on Medscape is good and has some very interesting comments that express a few of my conclusions.  Then Gretchen Becker has a different source and writes about this topic from a different perspective.

There are other blogs about this topic, but I still believe that this is discrimination against the elderly, especially the way the study was performed and even more the way it was presented. 

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