For people with diabetes, taking medications and monitoring their blood sugar is part of the rhythm of their daily lives. However, according to new research from Mayo Clinic, more than 20% of adult patients in the U.S. are likely treated too intensively. This has caused thousands of potentially preventable emergency department visits and hospitalizations for hypoglycemia (low blood sugar).
The study team, led by Rozalina McCoy, M.D., an endocrinologist and primary care physician at Mayo Clinic, sought to identify the real-world implications of intensive glucose lowering therapy across the U.S. The team show that overly intensive glucose-lowering therapy when patients receive more medication than is require base on their hemoglobin A1C level was not only common across the U.S., but also directly contribute to 4,774 hospitalizations and 4,804 emergency department visits in a two year period.
“While some episodes of hypoglycemia may be unavoidable, especially if caused by unmodifiable risk factors such as need for insulin therapy, others may be preventable; as in the case of overtreatment,” she states. “In an earlier study, they separate out the effect of overtreatment from other high risk factors; also show it was a significant independent contributor to hypoglycemic events,” says Dr. McCoy. “In this study, they want to learn more about national scope of those overtreatment relate events.”
“Because there is no U.S.-wide data about how many hypoglycemic events may be avoid if patients were treat less intensively; they had to separately calculate how many Americans are over treat,” continues Dr. McCoy. “They then use data from the earlier study, combine with this new data, to estimate the number of hypoglycemia relate emergency department visits and hospitalizations likely cause by overtreatment.”
Serious adverse effects
“Hypoglycemia, or low blood glucose, is one of the most common serious adverse effects of diabetes therapy; which causing both immediate and long-term harm to patients who experience it,” says Dr. McCoy. “Severe hypoglycemia, define by the need for another person to help the patient treat and terminate their hypoglycemic event; which is with increase risk of death, cardiovascular disease, cognitive impairment, falls and fractures, and poor quality of life.”
Historically, professional societies and regulatory bodies largely focus on reducing undertreatment and controlling hyperglycemia (low blood sugar). Dr. McCoy hopes to see a shift to also include addressing and preventing overtreatment and hypoglycemia. “They need to align treatment regimens and goals with each patient’s clinical situation, health status, psychosocial situation; also reality of everyday life to ensure that care is consistent with their goals, preferences and values,” she says.
If the health care system shifts from being disease focuse and for diabetes, specifically, glucose focuse to being more person-focused, she believes that will be less harmful, and lead to better outcomes for patients and less treatment burden. For patients with diabetes, she says, “this includes treatment de-intensification and simplification as a means of reducing hypoglycemia, polypharmacy and treatment burden.”