11% of older diabetes patients dangerously overtreated

Overtreatment of diabetes in elderly patients could be contributing to an increase in the number of falls, dizzy spells and confusion those individuals experience, according to research published in the Journal of General Internal Medicine.

Diabetes patients are generally treated for long-term care with aggressive blood sugar-lowering medications, lead researcher Michael L. Maciejewski, PhD, and co-authors wrote in the study. However, intense diabetic therapy isn’t always necessary in older patients, since the benefit of those aggressive treatments declines with age, while risks increase. The National Institute for Health and Care Excellence in the United Kingdom has released evidence that the benefits of aggressive glycemic control only begin eight years after initial treatment, Maciejewski noted in the study.

“Treating diabetes requires balancing the risks of long-term harm from undertreatment with the short-term and long-term harm from potential overtreatment,” he and colleagues wrote.

Researchers analyzed data from nearly 80,000 Medicare recipients with diabetes to complete this study, all of whom were 65 or older. After sorting through Medicare claims from 10 states, Maciejewski and his team found 8,560 of 78,792 patients—nearly 11 percent—were potentially being overtreated for diabetes, exposing them to risks like dizziness, confusion, falls or even death as a result of too-low blood sugar and blood pressure.

Comparatively, just 6.9 percent of patients in the cohort were suspected to be undertreated for their illness.

According to the study, rates of overtreatment were highest among those with dual eligibility for Medicaid (13.4 percent) and older individuals over age 75 (12.1 percent). Overtreatment was lowest among Hispanic patients.

Around 14 percent of the estimated 8,500 overtreated patients received deintensification treatment, Maciejewski and co-authors stated. Deintensification was most common in adults between 65 and 70 years old and Hispanic patients, as well as patients with six or more chronic conditions, those living in urban areas and those with more outpatient visits.

For patients over 75 years old, deintensification appeared to be rare.

“It is troubling that the oldest Medicare beneficiaries were more likely to be overtreated and less likely to have their medication regimens deintensified, because these older adults are least likely to benefit from tight glycemic control and most likely to be harmed,” Maciejewski and colleagues wrote. “It is encouraging that those with multiple chronic conditions were more likely to receive deintensification, because they often have complex medication regimens, and prior studies have shown that risk for hypoglycemia increases with age, comorbidity burden and polypharmacy.”

While Maciejewski’s team analyzed this data several years ago, they noted in their research the American Geriatrics Society began recommending less intense diabetes treatment in 2013, so rates in 2017 could be lower than what they found.

“By focusing at both the overtreatment and undertreatment ends of the diabetes quality spectrum, we can best begin to truly improve the quality of diabetes care, ensuring that patients get needed care while avoiding unnecessary potential harm,” the authors wrote.