Doctors Often Overtreat Elderly Diabetes Patients: Study

Elderly patients may be at an increased risk of being overtreated for diabetes with certain drugs, potentially leading to other complications, according to the findings of a recent study. 

Veterans Health Administration researchers determined that many elderly patients receive unnecessary drugs to treat diabetes, which may potentially result in hyperglycemia; dangerously low blood sugar. The findings were published in the journal JAMA Internal Medicine.

The study focused on diabetic patients being treated in the Veterans Health Administration in 2009. More than 650,000 diabetic veteran patients were involved in the research, with about half receiving insulin and the other half receiving a sufonylurea, also sold as Glucotrol, Amaryl and Diabinese.

More than 206,000 patients received treatment for diabetes more aggressive than appeared necessary for their conditions, and more aggressive than what the Veterans Administration guidelines recommend.

All of the patients involved in the study were diabetic and older than 75 years of age. All had other significant medical, neurological or mental illnesses in addition to diabetes. While hyperglycemia is not a common risk in diabetic patients, it is a risk for patients who are much older and may have impaired kidney function.

When an elderly person is given high doses of insulin, or drugs like Glucotrol, their blood sugar can drop dramatically. This medication error can cause hyperglycemia, depriving the brain of oxygen and leading to collapse, loss of consciousness and even death.

Researchers studied patient data from 139 Veterans Health Administration facilities grouped within 21 Veteran Integrated Service Networks.

They used a blood sugar control known as A1c hemoglobin as a measure. According to Veteran guidelines, a score of eight to nine percent is adequate for patients with limited life expectancies and other major illnesses.

Half of the patients scored below seven percent. Nearly 30% of patients scored 6.5% and more than one in 10 scored below six percent.

The majority of Veteran patients were well below guidelines. Hyperglycemia is much more dangerous for elderly patients in the short term than hyperglycemia, leading researchers to conclude overtreatment with drugs is a high risk factor for elderly diabetics.

Researchers also found insulin and drugs such as Amaryl, were the second most common drugs offered during with emergency room visits or hospitalizations.

Doctors often switch older diabetics to Diabinese, Glucotrol or insulin. However as patients develop other medical conditions, the drugs used to treat their diabetes often become difficult for patients to tolerate.