Intensive glucose-lowering treatment may be risky for older people with type 2 diabetes
Intensive glucose-lowering therapy may be putting certain people with type 2 diabetes at risk of dangerously low blood glucose levels, according to a new study.
The Mayo Clinic, Rochester, Minnesota, investigated the association between intensive glucose-lowering treatment and severe hypoglycemia.
For the study, intensive treatment was defined by a combination of how low the participants’ HbA1c was and the amount of diabetes medication they were taking.
Severe hypoglycemia is a serious complication that can sometimes lead to unconsciousness or, in rare cases, coma and even death.
Information from over 31,500 American adults with type 2 diabetes was brought together and analyzed as part of the study. At the beginning of the study, these participants were not taking insulin to manage their diabetes, and they didn’t have a history of severe hypoglycemic episodes.
It found that 25 percent of the participants received intensive glucose-lowering treatment, including 18.7 percent who were at risk of treatment-related hypoglycemia.
Clinical guidelines recommend a HbA1c of less than 7.0%, but there is an argument that those who are a lot older, have a limited life expectancy, or have complex health problems would not benefit much from a HbA1c level this low, and instead an intensive therapy puts them at risk.
In fact, participants that are older or had complex health problems were almost twice as likely to experience a severe hypoglycemic episode. Over a two-year period, the study found that intensive glucose-lowering treatment increased this risk by another 77 percent.
The participants’ medications significantly affected the rate at which they experienced severe hypoglycemia. It was found that patients who were prescribed glinides or sulfonylureas (drugs which actively stimulate the production of insulin by the pancreas) had more than double the risk of a severe hypo after just two years.
“In this study, we found that, particularly among older patients and patients with serious chronic conditions, intensive treatment nearly doubled the risk of severe hypoglycemia requiring medical attention, including hospitalization,” said lead author Dr Rozalina McCoy. “This means that three out of 100 older or clinically complex patients with [type 2] diabetes who never had hypoglycemia before, whose [blood glucose levels are] within recommended targets and who are not on insulin will experience a severe hypoglycemic episode at some point over two years.”
The findings did not look into the event rate of milder hypoglycemic episodes, which can still pose significant risks to health, and is a cause for concern and further investigation.
The findings were published online in the journal JAMA Internal Medicine.
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