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The U.S. Might Be Overtreating Diabetes

Many older patients get drugs they may not need, which could put them at risk of harmful side effects
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American doctors may be giving drugs to a lot of older diabetic patients who are unlikely to benefit and might even be harmed, a new study in JAMA Internal Medicine suggests. Older, sicker patients are treated as aggressively to get their blood sugar under control as healthier patients are, according to an analysis of a nationally representative survey of Americans 65 and older. That's despite what researchers say is greater risk that they'll suffer from dangerously low blood sugar, known as hypoglycemia, and little evidence that they benefit from intense diabetes management.

About 21 million Americans have been diagnosed with diabetes, and another 8 million are undiagnosed, according to the Centers for Disease Control (CDC). The prevailing approach to treating diabetes is to get a measure of patients' average blood sugar over several months, known as hemoglobin A1C, to below 7 percent, says Kasia Lipska, an endocrinologist at the Yale School of Medicine and lead author of the study. But in people with poor health, especially, the benefits of reaching that blood sugar level need to be weighed against the risks of treatment, including hypoglycemia, which can lead to confusion, accidents, falls, comas, or even death. "It’s clearly recognized by guidelines and by some prior research that these strategies are unlikely to result in benefit in people with poor health, and more likely to increase the risk of harm," Lipska says.