One Size Doesn’t Fit All in Diabetes Treatment
Diabetes treatment is based around the tight management of blood sugar levels via healthy eating, physical activity, regular monitoring, and medication or insulin if required. While this is effective in younger patients, a new study has found that a ‘one size fits all approach’ to diabetes control could lead to over treatment and potential harm in older patients.
Diabetes is very common in the older population – in the UK around 1 in 20 people over 65 have T2DM, and in the US nearly 12 million seniors are reported to have either diagnosed or undiagnosed diabetes. Despite these figures, the optimal way to manage glucose levels in this population is currently poorly defined, potentially not taking into account health status and other comorbidities a patient might have. For younger diabetics, blood glucose levels are considered to be controlled well if they are near to ‘normal’ ranges, and the ADA recommends achieving a hemoglobin A1c (HbA1c) level below 7%. However, it is not known if aggressively lowering blood sugar to this level in older diabetics provides a benefit, and could instead risk hypoglycemia which could cause serious health concerns including confusion, coma, and even death in extreme cases. A recently published study in JAMA Internal Medicine has investigated glycemic control in older diabetes patients with the aim of finding out what level of over treatment in blood sugar lowering is actually taking place.
The research used the NHANES from 2001 through 2010 to study nearly 1,300 people over 65 with diabetes, who were classified as being relatively healthy, having complex/intermediate health, or having very complex/poor health status (dependent on other illnesses, chronic conditions, or impairments on activities of daily living). The results showed that 62% of the subjects had HbA1c levels below 7%. Nearly two-thirds of the subjects with complex/intermediate health or very complex/poor health were defined as having ‘tight glycemic control’, with around 60% being treated with insulin or sulfonylureas to achieve this target. These subjects are unlikely to experience the benefits of this rigid control, and are more likely to experience hypoglycemia or other adverse effects, and are essentially being over treated for their diabetes. The study did not find significant changes in treatment patterns over time, meaning evolution of older patient care is not taking place.
The study shows that a ‘one size fits all’ approach is being overused in the diabetes population, and that a more personalized system is required for treatment. The authors suggest that healthy patients over 65 may still benefit from rigorous blood glucose control, but that ‘less is more’ in terms of treatment may be beneficial for those with other conditions and worsening health.
Crown Bioscience welcomes studies that can improve the day to day life of people living with chronic illnesses such as diabetes. We support research into novel therapies which can control the disease with fewer side effects and complications. This could improve the quality of life of all diabetes patients, including the older population if and when they really need antidiabetic treatment. Crown Bioscience provide clinically relevant in vitro and in vivo diabetes models for translational sciences and drug discovery, including the world’s largest collection of well characterized naturally diabetic non-human primate models (D*Prime). Our non-human primate models mirror all aspects of human diabetes, including disease progression, and provide the optimum research model for all of your translational needs. As many next generation antidiabetic agents target disease complications rather than just blood glucose control, non-human primate models are also an invaluable resource for understanding efficacy, PK/PD relationship, biomarkers, and possible adverse effects before moving on to successful human clinical trials
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