New research from the Mayo Clinic in Rochester, MN, warns that the United States faces an
extremely dangerous problem: the overtreatment of diabetes.
According to the study paper — which now appears in the journal Mayo Clinic Proceedings —
many people receive too much glucose-lowering therapy.
This increases a person’s risk of hypoglycemia or abnormally low blood sugar levels.
Hypoglycemia, or low blood glucose, is one of the most common serious adverse effects of
diabetes therapy, causing both immediate and long term harm to [people] who experience it,"
explains lead researcher Dr. Rozalina McCoy.
Severe hypoglycemia, defined by the need for another person to help the patient treatment and
terminate their hypoglycemic event, is associated with increased risk of death, cardiovascular
disease, cognitive impairment, falls and fractures, and poor quality of life," she adds.
The researchers found that in the U.S., people with diabetes often receive much more medication
than their hemoglobin A1C levels would require. Hemoglobin A1C levels are a person’s average
blood sugar levels over a period of around 3 months.
In the cohort they studied, this resulted in 4,774 hospital admissions and 4,804 emergency
department visits in the span of 2 years.
Importantly, these numbers are a large underestimation of the true scope of overtreatment-
induced hypoglycemic events," warns Dr. McCoy.
The researchers used 2011–2014 data from the National Health and Nutrition Examination
The survey, as well as information from the OptumLabs Data Warehouse.
The team’s first step was to estimate how prevalent intensive glucose-lowering therapy was in the
The U.S. by using National Health and Nutrition Examination Survey data.
They defined intensive therapy" as taking one type of medication to achieve hemoglobin A1C
levels of 5.6% or under, or taking two or several types of medication to achieve hemoglobin A1C
levels of 5.7 to 6.4%.
Then, they used information from the OptumLabs Data Warehouse to estimate how many people
with diabetes had visited an emergency department or the hospital because of hypoglycemia
related to overly intensive treatment.
The team determined that 10.7 million nonpregnant adults with diabetes had hemoglobin A1C
levels within recommended levels (under 7%). Of these, however, almost 22% received intensive
This means that as many as 2.3 million people with diabetes received overly intensive treatment
between 2011 and 2014 in the U.S., the researchers found.
This was regardless of whether or not they had clinically complex profiles, such as:
being aged 75 or over
being limited in two or more daily activities, including eating or getting dressed, and
walking from room to room
having a diagnosis of end-stage kidney disease
having three or more chronic conditions
According to the study, 32.3% of the 10.7 million people in the cohort had clinically complex
profiles. However, this did not seem to have any bearing on whether or not an individual
received intensive treatment for diabetes.
Older people and others we consider clinically complex are more at risk to develop
hypoglycemia, as well as experience other adverse events because of intensive or overtreatment,"
notes Dr. McCoy.
However, at the same time, these [people] are unlikely to benefit from intensive therapy rather
than moderate glycemic control," she notes. When we develop a diabetes treatment plan, our
goal should be to maximize benefit while reducing harm and burden of treatment."
The researchers explain that currently, most policymakers and healthcare professionals are
committed to controlling hyperglycemia (high blood sugar levels) and reducing instances of
However, Dr. McCoy notes, there also needs to be more aware of the dangers of
We need to align treatment regimens and goals with each patient’s clinical situation, health
status, psychosocial situation, and reality of everyday life to ensure that care is consistent with
their goals, preferences, and values, she advises.
While some episodes of hypoglycemia may be unavoidable, especially if caused by
unmodifiable risk factors such as the need for insulin therapy, others may be preventable, as in the
case of overtreatment, explains Dr. Mc Coy.
She says that going forward, it is important that healthcare providers hit a balance in the
recommendations they issue to their patients with diabetes. It is important not only to ensure
that we do not undertreat our patients with diabetes, but also that we do not overtreat them
because both undertreatment and overtreatment can harm our patients, stresses Dr. McCoy.
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