Diabetes in elderly often overtreated: Study

Chennai: With changes in lifestyle, the prevalence of diabetes is likely to increase, especially among the elderly. However, the treatment has also to be as per the need as a recent study published in the Journal of General Internal Medicine suggests that elderly patients with diabetes are usually over-treated, putting them at an increased risk of cardiac issues, fractures, cognitive impairments and eventually death.

The study says that an aggressive control of blood glucose concentration i.e. glycaemic control may lead to an increased risk of cardiovascular disease, hypo-glycaemia and others. Medicos practice glycaemic control to return blood pressure, lipid levels, and blood glucose concentrations to normal.

However, elderly patients are often over-treated, as intensification can be helpful for some of the diabetics, and is usually beneficial if treatment is on an individual basis. Control on blood glucose concentration reduces microvascular risks as diabetic nephropathy, diabetic neuropathy, and diabetic retinopathy by keeping glycated hemoglobin levels low.

Diabetes has emerged as the biggest non-communicable diseases plaguing the population in the country today and is associated with premature morbidity, mortality, and risk of cardiovascular diseases. American Geriatrics Society suggests that medications other than metformin should be avoided when glycated hemoglobin levels are less than 7.5 per cent as there are more chances of developing complications than benefits for diabetes patients. 

Due to the heterogeneity of older people with diabetes, individualized care is recommended to address their needs after considering their functional status and life expectancy, say diabetologists. Doctors suggest that comprehensive geriatric assessment is important on the initial examination of older people with diabetes with an individualized goal of therapy aiming to provide better quality of life.