Image of a clinician advising a patient about diabetes care.
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Many older nursing home residents with diabetes are overtreated for their condition and are at high risk of low blood sugar, or hypoglycemia, a new Veterans Administration study finds.

Investigators conducted a cohort study among 7,422 VA long-stay nursing home residents diagnosed with type 2 diabetes. Most had evidence of tightly controlled blood sugar levels based on blood test results at the start of the study. But about 40% continued to receive insulin and other medications that increase hypoglycemia risk —even after blood tests suggested overtreatment.

Only 27% of overtreated and 19% of potentially overtreated residents had their blood sugar-lowering medications appropriately adjusted within two weeks, the researchers reported. What’s more, evidence of hypoglycemia not associated with this de-intensification, they found.

Residents with severe functional impairment, meanwhile, were less likely to continue to receive overtreatment, the authors noted.

Look for history of low blood sugar

The takeaway? Clinicians should consider deprescribing initiatives geared toward residents at high risk of harms and with low likelihood of benefit from intensive diabetes treatment, such as those with a history of hypoglycemia or high levels of cognitive or functional impairment, the authors concluded.

“I hope this work lays the foundation for future projects that promote appropriate de-intensification of glucose lowering medications in nursing home residents,” said lead author Lauren Lederle, M.D., of the San Francisco VA Medical Center.

The researchers defined diabetes overtreatment as HbA1c <6.5 with any insulin use, and potential overtreatment as HbA1c <7.5 with any insulin use or HbA1c <6.5 on any glucose-lowering medication other than metformin alone.

Full findings were published in the Journal of the American Geriatrics Society.

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