Time To Dial Back On Diabetes Treatment In Older Patients? Study Finds 11 Percent Are Overtreated
Follow all of ScienceDaily's latest research news and top science headlines ! Time to dial back on diabetes treatment in older patients? Study finds 11 percent are overtreated Overly aggressive treatment of blood sugar in older people with diabetes can harm -- but a new study finds it's still common Michigan Medicine - University of Michigan Almost 11 percent of Medicare participants with diabetes had very low blood sugar levels that suggested they were being over-treated, a new study finds. But only 14 percent of these patients had a reduction in blood sugar medication refills in the next six months. Anyone with diabetes who takes blood sugar medication knows their doctor prescribed it to help them. After all, the long-term effects of elevated blood sugar can harm everything from the heart and kidneys to the eyes and feet. But what if stopping, or at least cutting back on, such drugs could help even more in some patients? In some older people, such "deintensification" of diabetes treatment may be the safer route, because of the risks of falls and other issues that come with too-low blood sugar. But a new study in the Journal of General Internal Medicine suggests more doctors and such patients should work together to dial back diabetes treatment. Almost 11 percent of Medicare participants with diabetes had very low blood sugar levels that suggested they were being over-treated, the new study finds. But only 14 percent of these patients had a reduction in blood sugar medication refills in the next six months. Patients over age 75, and those who qualified for both Medicare and Medicaid because of low incomes or serious disability, were most likely to be over-treated. Those who lived in urban areas or were of Hispanic origin were less likely to be over-treated. Patients o Continue reading >>
Get Unlimited Access On Medscape.
WARNING: RISK OF THYROID C-CELL TUMORS In rodents, semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether Ozempic® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined. Ozempic® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk for MTC with the use of Ozempic® and inform them of symptoms of thyroid tumors (e.g. a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Ozempic®. Ozempic® is not recommended as a first-line therapy for patients who have inadequate glycemic control on diet and exercise because of the uncertain relevance of rodent C-cell tumor findings to humans. Ozempic® has not been studied in patients with a history of pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis. Ozempic® is not a substitute for insulin. Ozempic® is not indicated for use in patients with type 1 diabetes mellitus or for the treatment of patients with diabetic ketoacidosis. Pancreatitis: Acute and chronic pancreatitis have been reported in clinical studies. Observe patients carefully for signs and symptoms of pancreatitis (persistent severe abdominal pain, sometimes radiating to the back with or without vomiting). If pancreatitis is suspected, discontinue Ozempic® promptly and if pancreatitis is confirmed, do not restart. Diabetic Ret Continue reading >>
Association Between Different Hemoglobin A1c Levels And Clinical Outcomes Among Elderly Nursing Home Residents With Type 2 Diabetes Mellitus
Objective New guidelines recommend a target glycated hemoglobin (HbA1c) of 7.5% to 8.0% in elderly persons with type 2 diabetes mellitus (T2DM), but real-world data regarding outcomes associated with different HbA1c levels in the elderly are limited. This study assessed outcomes and their association with defined HbA1c thresholds and age ranges in insulin-treated, elderly, patients with T2DM in long-term care (LTC). Design Retrospective analysis of medical charts and the Minimum Data Set (MDS) for the period September 2010 through September 2011. Setting A total of 117 nursing homes in the United States. Participants Eligible patients had resided in LTC for 3 months or more, had at least 1 full MDS assessment, 2 or more records of insulin dispensing with no pump use, and 1 or more HbA1c measurements. Measurements Outcomes that were measured included hypoglycemia, ketoacidosis, infections, falls, hospitalization, and emergency room (ER) visits. Results A total of 583 patients were included (mean age 78.9 years, mean chart observation length 55 days). In all groups, hypoglycemia was lowest in patients with an HbA1c level higher than 9.0%. In patients 75 years or older, infection rates were highest when HbA1c levels were higher than 9.0%. Falls increased by HbA1c level in patients aged 65 to 74 years, but decreased by HbA1c levels in patients 85 years or older. Ketoacidosis, hospitalization, and ER visits were low in all groups. Conclusion These data suggest that better glycemic levels may not necessarily be associated with better clinical outcomes, and different age groups may exhibit different patterns, thereby supporting the call for individualized glycemic control among elderly patients. Continue reading >>
- Medication Adherence and Improved Outcomes Among Patients With Type 2 Diabetes
- Association of Glycemic Variability in Type 1 Diabetes With Progression of Microvascular Outcomes in the Diabetes Control and Complications Trial
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
What Is The Best A1c Level For Older Adults With Diabetes?
Researchers find that while an A1c closer to a normal level is best, their findings suggest older individuals with diabetes would benefit from personalized A1c goals. The Hemoglobin A1c (HbA1c) means glycosylated hemoglobin. Red blood cells live for approximately 3 months and sugar happens to stick to them so the HbA1c test (or A1c test) is a blood test that is able to measure this glucose amount and provide an overall view of blood sugar levels over the past 3 months. This is a test that is done at a doctor’s office or in a lab where blood is taken from a vein. The test results are given in percentages such as between 4 percent on up. The ADA recommends people with diabetes keep their A1c below 7 percent but states that personalized targets should be set for each individual. A person’s A1c level has been closely tied to a higher risk for death in middle-age populations. Research has shown that the lower the A1c, the better. However, it hasn’t been clear what the best A1c for older adults with diabetes should be, thus scientists in this study sought to find out the risk of death by A1c levels in older adults with and without diabetes. The researchers studied data involving 7,333 adults age 65 and up from the Third National Health and Nutrition Examination Survey called NHANES III which took captured data between 1994-1998 and Continuous NHANES between 1999-2004 as well as their linked mortality data through December 2011. They used Cox proportional hazards models to check the relationship between A1c levels and the risk of all-cause and cause-specific, (like heart disease or cancer) death, viewing separately for adults with and without diabetes. What is the Best A1c for Older Adults with Diabetes? Researchers wrote in their study abstract that over a median follow Continue reading >>
Overtreatment Of Elderly Diabetics
The last time I was directly responsible for treating diabetes was fifty years ago, when I was an intern in medicine at UCLA. In my subsequent career as a psychiatrist I was not directly responsible for diabetes care, and as an individual, I don’t have the condition. As a result, I haven’t kept up on diabetes treatment, so a June 11 article on “Diabetes Overtreatment in Elderly Individuals: Risky Business in Need of Better Management” was news to me. The opening two sentences of the American Diabetes Association’s article on “Tight Diabetes Control” make it sound as if “tight control” should be the goal of treatment: “Keeping your blood glucose levels as close to normal as possible can be a lifesaver. Tight control can prevent or slow the progress of many complications of diabetes, giving you extra years of healthy, active life.” In my uninformed state, that’s how I understood how diabetes should be managed, even for over 65ers. But I was wrong. Several paragraphs later there’s a very clear statement that elderly people with diabetes should be treated differently: “Elderly people probably should not go on tight control. Hypoglycemia [overly low blood sugar] can cause strokes and heart attacks in older people. Also, the major goal of tight control is to prevent complications many years later. Tight control is most worthwhile for healthy people who can expect to live at least 10 more years.” The American Geriatrics Society gives precise guidelines for the goal of diabetes treatment in over 65ers. The key measure of diabetes control is hemoglobin A1c. For healthy over 65ers with long life expectancy, the target should be 7.0 – 7.5%. For those with “moderate comorbidity” (so-so health) and a life expectancy of less than 10 years the targe Continue reading >>
Older Diabetics May Be Pushing Blood Sugar Too Low
(Reuters Health) – Older diabetics may sometimes do too good a job at keeping their blood sugar down, according to a new study. Regardless of age, people with diabetes are taught to keep their blood sugar below certain target levels. But many diabetics over 65 who have other health concerns may be at risk for pushing it too low, according to a new study. Particularly for older adults with multiple serious illnesses and functional limitations, the risks of low blood sugar, or hypoglycemia, may outweigh the benefits of tight blood sugar control, the authors write. “Older people are more susceptible to hypoglycemia,” said lead author Dr. Kasia J. Lipska of the Yale School of Medicine in New Haven, Connecticut. “As people age, their kidney function deteriorates and drugs (like insulin) may not be eliminated from the body as efficiently,” which can lead to low blood sugar, she told Reuters Health by email. Often, people with low blood sugar don’t realize they have it. Symptoms can include double or blurry vision, rapid heartbeat, headache, hunger, shaking or trembling, sweating, tiredness or weakness or feeling faint, trouble sleeping, unclear thinking, and other problems. Severe low blood sugar can cause seizures and brain damage. Intense diabetes treatment, which the study showed many older people are doing, increases the risk for hypoglycemia two to three fold, Lipska said. Her team used data on 1,288 diabetics age 65 or older, from the National Health and Nutrition Examination Surveys from 2001 through 2010. Based on their ability to complete activities of daily life, about half of the participants were generally healthy, 28 percent had “complex or intermediate” health and 21 percent had “poor” health. To see how tightly these patients were controllin Continue reading >>
Achieving Glycemic Control In Elderly Patients With Type 2 Diabetes: A Critical Comparison Of Current Options
1Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; 2Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA; 3Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan Abstract: The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the elderly. Because of the unique characteristics of elderly people with T2DM, therapeutic strategy and focus should be tailored to suit this population. This article reviews the guidelines and studies related to older people with T2DM worldwide. A few important themes are generalized: 1) the functional and cognitive status is critical for older people with T2DM considering their life expectancy compared to younger counterparts; 2) both severe hypoglycemia and persistent hyperglycemia are deleterious to older adults with T2DM, and both conditions should be avoided when determining therapeutic goals; 3) recently developed guidelines emphasize the avoidance of hypoglycemic episodes in older people, even in the absence of symptoms. In addition, we raise the concern of glycemic variability, and discuss the rationale for the selection of current options in managing this patient population. Keywords: glycemic target, glycemic variability, blood glucose, frailty Diabetes prevalence in older people increases with advancing age. The global prevalence of diabetes in people between the ages of 60 and 79 is 18.6%, which is more than 134.6 million people, and accounts for 35% of all cases of diabetes in adults.1 Peripheral neuropathy, which is highly prevalent in older people with diabetes, increases the risk of falls and fractures, and consequently, of functional impairment.2 Continue reading >>
- The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
- Association of Glycemic Variability in Type 1 Diabetes With Progression of Microvascular Outcomes in the Diabetes Control and Complications Trial
- Highs & Lows: Reevaluating Hypoglycemia in Elderly Diabetes Patients
Diabetic Hemoglobin A1c Goals May Be Too Low For Older Patients
Diabetic hemoglobin A1C goals may be too low for older diabetics. Here is why and what some doctors think should change. Because the A1C is so new, doctors are still learning what number is the best goal for diabetes control. In 1986 the testing program was given to doctors to provide a clearer picture of blood sugar control in diabetics. They hoped to find that a lower number on the A1C improved diabetic complications. On the diabetic hemoglobin A1C, non-diabetics test in the 4% to 6% range. But a type 2 diabetic can test 10% or higher. Studies find that at levels higher than 8%, the complications multiply. The National Institute of Health says half of type 2 diabetics have poor blood sugar control in the U.S. So doctors hope the diabetic hemoglobin A1C will become a powerful tool for change. So far it seems to be working. But what is the perfect number for a diabetic? For a while they thought the perfect number for a diabetic was 7%. But diabetes doctors want to lower the goal to 6.5% or less. They say this will keep the heart, kidney, retinal and peripheral diseases from getting worse in type 1 and type 2 diabetes. There is no doubt that a lower diabetic hemoglobin A1C does equal fewer complications. A lower A1C means you have fewer AGEs, in your body. So you have less damage to your organs - your brain, heart, blood vessels and eyes. But the A1C cannot tell you how often you have those dangerous low blood sugars. Diabetic medications are a common cause of hypoglycemia as you attempt to lower the sugar in your blood by artificial means. Your endocrine system is a complex and sensitive organism. Medications cannot hope to duplicate it. Hormones regulate your blood sugar with tiny adjustments. If it dips too low your body releases epinephrine, making you feel nervous. Continue reading >>
Poor Diabetes Control Found In Older Americans
Researchers say many fall short of targets even when using less stringent guidelines for blood sugar, cholesterol and blood pressure levels Only one in three older Americans have their diabetes under control as measured by guidelines set by the American Diabetes Association, new Johns Hopkins Bloomberg School of Public Health research suggests. Some argue that ADA guidelines may be too stringent for some older adults. But even using less stringent measures, the researchers found, there are still many older Americans whose diabetes is not well managed, a condition that can lead to multiple long-term health problems ranging from kidney disease to blindness. In a report published in the July issue of Diabetes Care, the researchers also found serious racial disparities, primarily in women, in how well diabetes is being managed, with black women much less likely to have acceptable blood sugar, blood pressure and cholesterol levels than white women. The findings suggest that there is a lot of work to be done to care for people with diabetes over the age of 65, a population universally eligible for government-funded health care through Medicare. But the research also raises questions about the value of broad guidelines for glucose and blood pressure control in older Americans considering that medications to lower blood sugar and blood pressure come with potentially serious side effects that may outweigh the benefits of pushing for lower sugar and blood pressure levels. “This research gives us a good picture of diabetes control in older adults and gets us thinking about what it means that older Americans are not meeting clinical targets and how we should address this from a public health perspective,” says study leader Elizabeth Selvin, PhD, MPH, a professor of epidemiology Continue reading >>
Your A1c Levels – What Goal To Shoot For?
Measuring Your A1C An A1C test gives you and your provider insight into all of your blood glucose ups and downs over the past two or three months. It’s like the 24/7 video of your blood sugar levels. Observing your A1C results and your blood glucose (also known as blood sugar) results together over time are two of the key tools you and your health care provider can use to monitor your progress and revise your therapy as needed over the years. Recent research is changing the way health professionals look at A1C levels. Instead of setting tight controls across the board, a healthy A1C level is now a moving target that depends on the patient. In the past, an A1C of 7 percent was considered a healthy goal for everyone. Yehuda Handelsman, M.D., medical director of the Metabolic Institute of America in Tarzana, California, says experts now recommend taking a patient-centered approach to managing A1C levels, which means evaluating goals based on individual diabetes management needs and personal and lifestyle preferences. Current ADA Goals The 2015 American Diabetes Association (ADA) Standards of Medical Care in Diabetes advise the following A1C levels: • 6.5 percent or less: This is a more stringent goal. Health care providers might suggest this for people who can achieve this goal without experiencing a lot of hypoglycemia episodes or other negative effects of having lower blood glucose levels. This may be people who have not had diabetes for many years (short duration); people with type 2 diabetes using lifestyle changes and/or a glucose-lowering medication that doesn’t cause hypoglycemia; younger adults with many years to live healthfully; and people with no significant heart and blood vessel disease. • 7 percent: This is a reasonable A1C goal for many adults with d Continue reading >>
Why Is Diabetes So Bad?
I’ll answer from a doc’s perspective (having been a pre-diabetic for many years, a few years a type 2 diabetic not on meds, after losing weight and more exercise back to being a pre-diabetic again): Diabetes is much more than just an elevated blood sugar. It involves one’s whole body. It can and often does lead to serious complications: -even in well controlled diabetes, middle aged diabetics people have a much higher rate of having a myocardial infarctions, as if they already had had one before AKA “risk equivalent” this is why all middle aged diabetics are prescribed a statin, even when having normal serum lipids, this has been proven to lower the risk for a myocardial infarction by 25%, not to the level of non diabetics -in diabetics strict blood pressure control <130/80 mmHg is needed so not to develop diabetic kidney disease, the number one reason for end stage kidney failure -strict blood sugar control will largely prevent diabetic retinopathy/eye disease from developing, of not regularly checked for and if needed treated will lead to calamitous blindness. -strict blood sugar control also will lower the risk for nerve damage, diabetic polyneuropathy, which usually causes a terrible burning pain in the legs, sometimes arms, loss of gnostic (feeling how a limb/finger is positioned) feeling, leading to loss of balance and falls, in more severe cases loss of muscle strength, even leading of paralysis of the stomach (vomiting, thus risking low blood sugars) and/or treatment resistant constipation: autonomic neuropathy. A lower HBA1c, reflecting an overall better diabetes regulation, In the middle aged, but especially in the elderly, a HBA1c of less than 6% correlates with more deaths, probably because of more unfelt (e.g. nightly) low blood sugar episodes in Continue reading >>
Setting Appropriate A1c Goals For Patients With Type 2 Diabetes
Reviewed by Clifton Jackness, MD, Attending Physician in Endocrinology, Lenox Hill Hospital and the Mount Sinai Medical Center, New York, NY Assessment of glycemic control in patients with type 2 diabetes can be achieved through patient self-monitoring of blood glucose (SMBG) and A1C determinations.1,2 The American Diabetes Association (ADA) recommends regular A1C testing to evaluate the effectiveness of current management strategies, but the target A1C goal can vary depending on the individual patient profile as well as the set of professional consensus recommendations—and associated management philosophy—to which the treating clinician adheres. According to the ADA, the generally accepted standard A1C goal for adult patients with type 2 diabetes is 7.0%.1,2 Driving A1C below this level has been shown to reduce microvascular complications. In addition, if achieved quickly after a diabetes diagnosis, this A1C goal has been associated with a long-term reduction in macrovascular disease as well.1,2 The ADA suggests that physicians may lower the A1C target to 6.5% for some individuals with short duration of diabetes, a long life expectancy, and no significant cardiovascular disease if the target can be achieved without significant adverse effects of therapy, most notably hypoglycemia.2 Conversely, the ADA suggests a target A1C of closer to 8.0% for individuals with any of the following: history of severe hypoglycemia limited life expectancy advanced microvascular or macrovascular complications multiple comorbidities The higher target A1C is also recommended for patients for whom long-term management of diabetes with behavior modification, SMBG, and glucose-lowering therapy has not helped attain a lower target goal.1,2 These ADA recommendations are partly based on studi Continue reading >>
Original Study Association Between Different Hemoglobin A1c Levels And Clinical Outcomes Among Elderly Nursing Home Residents With Type 2 Diabetes Mellitus
Abstract New guidelines recommend a target glycated hemoglobin (HbA1c) of 7.5% to 8.0% in elderly persons with type 2 diabetes mellitus (T2DM), but real-world data regarding outcomes associated with different HbA1c levels in the elderly are limited. This study assessed outcomes and their association with defined HbA1c thresholds and age ranges in insulin-treated, elderly, patients with T2DM in long-term care (LTC). Retrospective analysis of medical charts and the Minimum Data Set (MDS) for the period September 2010 through September 2011. Eligible patients had resided in LTC for 3 months or more, had at least 1 full MDS assessment, 2 or more records of insulin dispensing with no pump use, and 1 or more HbA1c measurements. Outcomes that were measured included hypoglycemia, ketoacidosis, infections, falls, hospitalization, and emergency room (ER) visits. A total of 583 patients were included (mean age 78.9 years, mean chart observation length 55 days). In all groups, hypoglycemia was lowest in patients with an HbA1c level higher than 9.0%. In patients 75 years or older, infection rates were highest when HbA1c levels were higher than 9.0%. Falls increased by HbA1c level in patients aged 65 to 74 years, but decreased by HbA1c levels in patients 85 years or older. Ketoacidosis, hospitalization, and ER visits were low in all groups. These data suggest that better glycemic levels may not necessarily be associated with better clinical outcomes, and different age groups may exhibit different patterns, thereby supporting the call for individualized glycemic control among elderly patients. Continue reading >>
- Medication Adherence and Improved Outcomes Among Patients With Type 2 Diabetes
- Major Study Confirms Racial Disparities Related to Key Diabetes Indicator, Hemoglobin A1c
- Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study
Treatment Of Type 2 Diabetes Mellitus In The Older Patient
I Have Diabetes Mellitus But Am Very Responsible, Checking Levels Regularly. I Get A Hgba1c Blood Test Every 3 Months & Even If It Increases Minimally, It Freaks Out My Doctors. What Does It Impact?
What are you on against your diabetes, tablets, insulin, or both? It has been shown that self measurement of blood glucose levels in those on tablets did improve diabetic control, by giving their doc an earlier feedback so treatment could be adjusted, see Is self-monitoring of blood glucose effective in improving glycaemic control in type 2 diabetes without insulin treatment: a meta-analysis of randomised controlled trials; and it’s an essential part of diabetes management, enabling one to adjust insulin dosing according the the blood glucose levels measured. Any lifestyle modifications like regular exercise and weight control? Please see the 50% success of this latest trial reported one year after people lost 15 kg after being on a liquid 600 Cal diet for 6 months, 50% of the participants were cured of their diabetes Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial What are your HbA1c values this last year? Has it lead to changes in your treatment at all? This graph shows you the impact of badly controlled diabetes as shown by too high HbA1c values, so in younger people we strive for values between 6.5 to 7% In the elderly we should strive for higher HbA1c values of 7 to 7.5%, since lower values are correlated with more deaths, and more cognitive loss: A later June 2011 paper studying diabetics older than 60 yo Glycemic Control, Complications, and Death in Older Diabetic Patients: The Diabetes and Aging Study showed that a optimal HBA1c in relation to mortality is between 6.0% to 7.9%, even up to 8.9%: In geriatric patients (mean age 80 years old) it seemed that a HBA1c of 8% - 8.9% had the lowest mortality see this Juli 2012 paper Hemoglobin A1c and Functional Decline in Community-Dwelling, Nursing Continue reading >>