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Could your diabetes treatment be doing more harm than good?

Kathleen Blanchard's picture
Some people may be in harm's way from type 2 diabetes medication

New research questions the value of medications for type 2 diabetes that for some can be just too risky.The finding challenges the idea that everyone with diabetes must reach targeted blood sugar goals.

Medications for type 2 diabetes no benefit for some

According to the study that was published in the Journal of the American Medical Association Internal Medicine June 30, 2014, medications for type 2 diabetes may have no benefit for some people, especially those over age 50.

University of Michigan Health System, the VA Ann Arbor Healthcare System, and University College London.researchers say weight gain and frequent insulin shots provide minor benefits that are outweighed by the hassles of giving injections and other risks such as low blood sugar.

“For people with type 2 diabetes, the goal of managing blood sugar levels is to prevent associated diabetes complications, such as kidney, eye and heart disease, but it is essential to balance complication risks and treatment burdens when deciding how aggressively to treat blood sugars,” says lead author Sandeep Vijan M.D., M.S., professor of Internal Medicine at the U-M Medical School and research scientist at the Center for Clinical Management Research at the VA Ann Arbor Healthcare System in a press release.

Vijan points out a goal of treating type 2 diabetes is to also improved quality of life. If you're a patient taking insulin or other diabetes drugs and you're gaining weight and having difficulty with hypoglycemia, diabetes drugs may be doing you more harm than good.

He adds keeping blood sugars in the moderate range may be good enough, especially if you are at already low-risk for complications. Once a certain target it reached more intense treatment may not even be necessary.

By age 75 the harm of treating type 2 diabetes aggressively are likely to outweigh any benefits Vijan said.

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Just 15 to 20 percent of people need aggressive diabetes treatment

People with very high glucose levels and type 2 diabetes are excluded from the suggestions however.

High blood sugar levels, defined by HbA1c measurements should be treated more aggressively the study found.

A better approach to diabetes treatment the authors say is individualized therapy.

When deciding on aggressiveness of therapy it's important to gauge a patient's risk of kidney, eye and vascular disease.

Approximately 15 to 20 percent of adults with type 2 diabetes would require aggressive type 2 diabetes treatment the study authors estimate.

“Current quality measures do not allow doctors and patients to make good decisions for each patient because they emphasize reaching targets instead of thinking of the risks and benefits of starting new medications based on individual circumstances and preferences,"

Senior author Rodney Hayward, M.D., professor of medicine in the U-M Medical School and senior research scientist at the Center for Clinical Management Research at the VA Ann Arbor Healthcare System says the finding has "major" implications for millions with type 2 diabetes who are being told to increase their medications to get their blood sugars to goal that in the long-run could carry more risks than benefits.

"The effect of patients’ risks and preferences on health gains with glucose lowering in type 2 diabetes: Patient preferences and outcomes of glycemic control”
JAMA Internal Medicine, June 30, 2014.

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