December 14, 2015
Are Seniors Being Treated Properly?
A recent newsletter from diaTribe caught my attention, particularly an article by Kelly Close. Her article is titled, “How Should We Be Treating Seniors with Diabetes?” I must admit that it raises some valid points, but in the back of my mind, I feel that it missed some important points.
The article she used is a New York Times article about a hypothetical patient with type 2 diabetes, concocted by researchers at the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System. The NY Times article is not an article we should pay a lot of attention to or be overly concerned about because this is done like most articles as a “one-size-fits-all” example.
Kelly says of the NY Times article, “The article raises important concerns about the overtreatment of people with diabetes; however, it fails to address the growing number of methods designed to minimize these very risks that are so very important as this epidemic expands beyond what anyone imagined.”
I can agree with the statement, but I need to be concerned about the next statement - “It is true that most mealtime insulins, as well as sulfonylureas, come with a meaningful risk of hypoglycemia. As a person with diabetes, I welcome the chance to mitigate this risk. However, in just the past decade, many new diabetes drug classes now exist with virtually no risk of low blood sugars (incretins, SGLT-2 inhibitors). And more importantly, at least one of these drugs, Jardiance (empagliflozin), recently showed reduced cardiovascular risk in high-risk elderly people with type 2 diabetes.
With the recent FDA warnings issued forSGLT2 inhibitors, I would be hard pressed to agree that this class of drugs should be considered as something that helps mitigate this risk of problems for people with diabetes. I may be overly conservative, but I only consider one oral medication worth considering in the treatment of diabetes and that drug is metformin. And with insulin, these are the only drugs I can say that I approve of and consider the rest unsafe for people with diabetes.
Granted some people can tolerate some of the other classes of drugs, but when it comes to the elderly (or seniors) no testing has been done on the drugs for the elderly. The drugs are just prescribed with no information available on how the elderly will react to the drugs or if they will even work as they do on younger patients.
When dealing with seniors, more care must be taken and each prescription needs to be monitored carefully to discontinue the drug quickly if certain side effects become evident.
Plus when dealing with the elderly, cognitive ability must always be a consideration and many drugs need to be off the table when cognition problems are discovered. Another factor often overlooked is the caregivers for the elderly. What are their abilities and how much knowledge are they willing to absorb to be able to care for the elderly.
One of the greatest problems facing the elderly of today is the physicians that want to bully them and not listen to their or the caregivers descriptions of what might be wrong with the patients. They often just hand out a fist full of prescriptions and expect the patient to take or be given the medications as directed. They know little about geriatrics and often don't even care.
For the reasons above and our poor medical system, the elderly are not properly cared for or treated with respect.