News ID: 257400
Published: 0732 GMT August 17, 2019

Diabetes overtreatment seriously endangers health

Diabetes overtreatment seriously endangers health
medscape.com

People with diabetes, particularly those with type 1 diabetes, may have an increased risk of hypoglycemia (low blood sugar) if they receive too much glucose lowering therapy.

New research now warns that many people with diabetes face that risk, medicalnewstoday.com wrote

In 2018, Medical News Today reported on a study warning that many people with type 2 diabetes may be overmonitoring their glucose levels, which may lead to the misuse of tests and supply waste.

Now, new research from the Mayo Clinic in Rochester, Minnesota, warned that the United States faces a much more dangerous problem: The overtreatment of diabetes.

According to the study paper — which now appears in the journal Mayo Clinic Proceedings — many people receive too much glucose lowering therapy.

This increases a person's risk of hypoglycemia, or abnormally low blood sugar levels.

"Hypoglycemia, or low blood glucose, is one of the most common serious adverse effects of diabetes therapy, causing both immediate and long term harm to [people] who experience it," explained lead researcher Dr. Rozalina McCoy.

"Severe hypoglycemia, defined by the need for another person to help the patient treat and terminate their hypoglycemic event, is associated with increased risk of death, cardiovascular disease, cognitive impairment, falls and fractures, and poor quality of life," she added.

The researchers found that in the US, people with diabetes often receive much more medication than their hemoglobin A1C levels would require. Hemoglobin A1C levels are a person's average blood sugar levels over a period of around three months.

In the cohort they studied, this resulted in 4,774 hospital admissions and 4,804 emergency department visits in the span of two years.

"Importantly, these numbers are a large underestimation of the true scope of overtreatment-induced hypoglycemic events," warned McCoy.

The researchers used 2011–2014 data from the National Health and Nutrition Examination Survey, as well as information from the OptumLabs Data Warehouse.

The team's first step was to estimate how prevalent intensive glucose lowering therapy was in the US by using National Health and Nutrition Examination Survey data.

They defined "intensive therapy" as taking one type of medication to achieve hemoglobin A1C levels of 5.6 percent or under, or taking two or several types of medication to achieve hemoglobin A1C levels of 5.7 to 6.4 percent.

Then, they used information from the OptumLabs Data Warehouse to estimate how many people with diabetes had visited an emergency department or the hospital because of hypoglycemia related to overly intensive treatment.

The team determined that 10.7 million nonpregnant adults with diabetes had hemoglobin A1C levels within recommended levels (under seven percent). Of these, however, almost 22 percent received intensive glucose lowering therapy.

This means that as many as 2.3 million people with diabetes received overly intensive treatment between 2011 and 2014 in the US, the researchers found.

This was regardless of whether or not they had clinically complex profiles, such as:

● Being aged 75 or over

● Being limited in two or more daily activities, including eating or getting dressed, and walking from room to room

● Having a diagnosis of end stage kidney disease

● Having three or more chronic conditions

 

According to the study, 32.3 percent of the 10.7 million people in the cohort had clinically complex profiles. However, this did not seem to have any bearing on whether or not an individual received intensive treatment for diabetes.

"Older people and others we consider clinically complex are more at risk to develop hypoglycemia, as well as experience other adverse events because of intensive or overtreatment," noted McCoy.

"However, at the same time, these [people] are unlikely to benefit from intensive therapy rather than moderate glycemic control," she noted.

"When we develop a diabetes treatment plan, our goal should be to maximize benefit while reducing harm and burden of treatment."

The researchers explained that currently, most policymakers and healthcare professionals are committed to controlling hyperglycemia (high blood sugar levels) and reducing instances of undertreatment.

However, McCoy noted, there also needs to be more awareness of the dangers of overtreatment.

"We need to align treatment regimens and goals with each patient's clinical situation, health status, psychosocial situation, and reality of everyday life to ensure that care is consistent with their goals, preferences, and values," she advises.

"While some episodes of hypoglycemia may be unavoidable, especially if caused by unmodifiable risk factors such as need for insulin therapy, others may be preventable, as in the case of overtreatment," explained Mc Coy.

She said that going forward, it is important that healthcare providers hit a balance in the recommendations they issue to their patients with diabetes.

"It is important not only to ensure that we do not undertreat our patients with diabetes, but also that we do not overtreat them because both undertreatment and overtreatment can harm our patients," stressed Dr. McCoy.

   
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