Elders with diabetes more likely to receive insulin, but less likely to benefit

Elders with diabetes and multimorbidity are more likely to hit low Hemoglobin A1c targets using high-risk medications than their younger cohorts, a new study finds. Patients would be better served if clinicians recognized the problem, the researchers say.

The counterintuitive findings come from claims and lab data culled from the OptumLabs Data Warehouse. According to investigators, older patients and patients with multiple chronic disease were more likely to be treated with insulin to achieve their HbA1c levels. This therapy choice puts them at risk for hypoglycemia, has uncertain long-term benefits, and may be in conflict with current guidelines, said Rozalina McCoy, M.D., M.S., from the Mayo Clinic.

“Our study suggests ample opportunity for insulin deintensification among older patients and patients with advanced and/or multiple comorbidities, which may lower their risk of hypoglycemia,” wrote McCoy and colleagues from Yale.

“Most importantly, clinicians should continue to engage their patients in shared and informed decision-making, weighing the risks and benefits of glucose-lowering treatment regimens,” the researchers concluded.

McCoy’s previous research has found that too many older, clinically complex patients with diabetes end up in emergency rooms due to overtreatment, as McKnight’s has reported.