Nav: Home

Too many older diabetes patients are being overtreated

September 14, 2017

Up to 11 percent of older Americans insured through Medicare are receiving too much medication to control their diabetes, and around 7 percent are being undertreated. This is according to a study in the Journal of General Internal Medicine which is published by Springer. The research involved the analysis of Medicare insurance claims data in 2011 from 78,792 diabetes patients 65 years and older living in ten eastern American states. Medicare is a US federal health insurance program primarily for people who are 65 or older.

In the article, study leader Matthew Maciejewski of Durham Veterans Affairs Medical Center and Duke University in the US warns against a one-size-fits-all approach when treating diabetes in older patients. He and his co-authors call for greater personalized care that takes account of the risks and benefits that such treatment holds for individual patients.

Diabetes treatment is a balancing act in which the risks and difficulties of treatment must be constantly weighed up against the potential harm of undertreatment. Aggressive blood sugar control can cause dangerously low blood sugar (called hypoglycemia), heart attacks or strokes, temporary cognitive impairment and fractures. In specific cases outlined by the American Geriatrics Society and the American Diabetes Association, it is appropriate to de-intensify therapy or remove prescribed treatments for older adults with well controlled diabetes.

The data show that 8,560 (10.9 percent) of older patients potentially received too much diabetes medication in 2011, while 5,487 (6.9 percent) were undertreated. Overtreatment was more likely among patients who were also eligible for Medicaid (healthcare for families and individuals with limited means) and those older than 75 years. Overtreatment was less likely among Hispanics and people living in urban areas.

The deintensification of diabetes therapy was more common for Medicare beneficiaries with six or more chronic conditions, as well as those who had more outpatient visits or who lived in urban areas. It was much less likely for patients older than 75 years.

"The oldest Medicare beneficiaries are the least likely to benefit from tight glycemic control and most likely to be harmed, so it is troubling that they were more likely to be overtreated and less likely to have their medication regimens de-intensified," explains co-author Sussman of Ann Arbor Veterans Affairs Medical Center and the University of Michigan.

"By focusing at both overtreatment and undertreatment ends of the diabetes quality spectrum, we can best begin to improve the quality of diabetes care in all respects, ensuring that patients get needed care while avoiding unnecessary potential harm," he adds.
-end-
Reference: Maciejewski, M.L. et al (2017). Overtreatment and Deintensification of Diabetic Therapy among Medicare Beneficiaries, Journal of General Internal Medicine DOI: 10.1007/s11606-017-4167-y

Springer

Related Diabetes Articles:

The role of vitamin A in diabetes
There has been no known link between diabetes and vitamin A -- until now.
Can continuous glucose monitoring improve diabetes control in patients with type 1 diabetes who inject insulin
Two studies in the Jan. 24/31 issue of JAMA find that use of a sensor implanted under the skin that continuously monitors glucose levels resulted in improved levels in patients with type 1 diabetes who inject insulin multiple times a day, compared to conventional treatment.
Complications of type 2 diabetes affect quality of life, care can lead to diabetes burnout
T2D Lifestyle, a national survey by Health Union of more than 400 individuals experiencing type 2 diabetes (T2D), reveals that patients not only struggle with commonly understood complications, but also numerous lesser known ones that people do not associate with diabetes.
Type 2 diabetes and obesity -- what do we really know?
Social and economic factors have led to a dramatic rise in type 2 diabetes and obesity around the world.
A better way to predict diabetes
An international team of researchers has discovered a simple, accurate new way to predict which women with gestational diabetes will develop type 2 diabetes after delivery.
The Lancet Diabetes & Endocrinology: Older Americans with diabetes living longer without disability, US study shows
Older Americans with diabetes born in the 1940s are living longer and with less disability performing day to day tasks than those born 10 years earlier, according to new research published in The Lancet Diabetes & Endocrinology journal.
Reverse your diabetes -- and you can stay diabetes-free long-term
A new study from Newcastle University, UK, has shown that people who reverse their diabetes and then keep their weight down remain free of diabetes.
New cause of diabetes
Although insulin-producing cells are found in the endocrine tissue of the pancreas, a new mouse study suggests that abnormalities in the exocrine tissue could cause cell non-autonomous effects that promotes diabetes-like symptoms.
The Lancet Diabetes & Endocrinology: Reducing sugar content in sugar-sweetened drinks by 40 percent over 5 years could prevent 1.5 million cases of overweight and obesity in the UK and 300,000 cases of diabetes
A new study published in The Lancet Diabetes & Endocrinology journal suggests that reducing sugar content in sugar sweetened drinks (including fruit juices) in the UK by 40 percent over five years, without replacing them with any artificial sweeteners, could prevent 500,000 cases of overweight and 1 million cases of obesity, in turn preventing around 300,000 cases of type 2 diabetes, over two decades.
Breastfeeding lowers risk of type 2 diabetes following gestational diabetes
Women with gestational diabetes who consistently and continuously breastfeed from the time of giving birth are half as likely to develop type 2 diabetes within two years after delivery, according to a study from Kaiser Permanente published today in Annals of Internal Medicine.

Related Diabetes Reading:

Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me
by Adam Brown (Author), Kelly L. Close (Foreword)

The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally
by Jason Fung (Author), Nina Teicholz (Foreword)

The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes
by Joel Fuhrman M.D. (Author)

Dr. Neal Barnard's Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes Without Drugs
by Neal Barnard (Author)

Diabetes For Dummies
by Alan L. Rubin (Author)

Mayo Clinic The Essential Diabetes Book
by Mayo Clinic (Author)

Diabetic Living Diabetes Meals by the Plate: 90 Low-Carb Meals to Mix & Match
by Diabetic Living Editors (Author)

The Official Pocket Guide to Diabetic Food Choices
by American Diabetes Association ADA (Author)

Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars
by Richard K. Bernstein (Author)

Choose Your Foods: Food Lists for Diabetes
by American Diabetes Association (Author)

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Dying Well
Is there a way to talk about death candidly, without fear ... and even with humor? How can we best prepare for it with those we love? This hour, TED speakers explore the beauty of life ... and death. Guests include lawyer Jason Rosenthal, humorist Emily Levine, banker and travel blogger Michelle Knox, mortician Caitlin Doughty, and entrepreneur Lux Narayan.
Now Playing: Science for the People

#491 Frankenstein LIVES
Two hundred years ago, Mary Shelley gave us a legendary monster, shaping science fiction for good. Thanks to her, the name of Frankenstein is now famous world-wide. But who was the real monster here? The creation? Or the scientist that put him together? Tune in to a live show from Dragon Con 2018 in Atlanta, as we breakdown the science of Frankenstein, complete with grave robbing and rivers of maggots. Featuring Tina Saey, Lucas Hernandez, Travor Valle, and Nancy Miorelli. Moderated by our own Bethany Brookshire. Related links: Scientists successfully transplant lab-grown lungs into pigs, by Maria Temming on Science...