Too many older, clinically complex patients with diabetes end up in U.S. emergency rooms due to overtreatment, according to a Mayo Clinic study published this month.
Glucose-lowering therapy is considered intensive when patients receive more medication than is required based on their hemoglobin A1C level. In their analysis, the researchers estimated that more than 2.3 million U.S. adult diabetes patients are treated too intensively.
This in turn has led to thousands of potentially preventable emergency department visits and hospitalizations for low blood sugar, wrote study lead and endocrinologist Rozalina McCoy, M.D. In fact, she and her team found that intensive treatment directly contributed to 4,774 hospitalizations and 4,804 emergency department visits in a two-year period. And some patients may be more at risk than others.
In 10.7 million diabetes patients McCoy studied, about 32.% were “clinically complex,” meeting the following criteria:
- Age 75 or older
- Two or more limitations on daily living activities, such as the inability to dress, feed, walk from room to room, or get in or out of bed
- End-stage kidney disease
- Three or more chronic conditions
This did not appear to be a factor in whether individuals were intensively treated, but it would have been ideal if it had been a factor, McCoy wrote.
“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. However, at the same time, these patients are unlikely to benefit from intensive therapy rather than moderate glycemic control,” said McCoy in a statement. “When we develop a diabetes treatment plan, our goal should be to maximize benefit while reducing harm and burden of treatment.”
The full findings were published online in Mayo Clinic Proceedings.
