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University research enourages new approach to treatment of diabetes for older patients

By Josh Qian, Daily Staff Reporter
Published July 2, 2014

A recent study by University researchers may change how healthcare professionals approach the treatment of elderly patients diagnosed with Type 2 diabetes.

The study, which was sponsored by the Department of Veterans Affairs and the Michigan Center for Diabetes Translational Research, demonstrated that the side effects of insulin shots might outweigh the benefits of the drug for patients over 50.

The findings were published Monday in the Journal of the American Medical Association Internal Medicine, a peer-reviewed journal providing clinically relevant research for practitioners.

Internal Medicine Prof. Sandeep Vijan, a research scientist at the Center for Clinical Management Research at the VA Ann Arbor Healthcare System, served as the lead author of the study. Vijan said the purpose of the study was to understand how the potential benefits balance against the side effects of glucose treatment and to identify populations who are least likely to see improvement in their quality of life with treatment.

“This was a statistical simulation using data from existing clinical trials,” Vijan said. “We created a model that estimates the risks of developing diabetes complications in individuals based on a variety of factors such as age and glucose levels, blood pressure and cholesterol levels.”

He said older patients also receive less comparative benefit because the glucose treatment can take 15 to 20 years to show a measurable effect in the reduction of the complications of diabetes, including heart disease, visual impairment and kidney failure, whereas decreases in quality of life and other negative side effects present much sooner.

“There is good evidence that the treatments themselves can reduce quality of life,” Vijan said. “For example, patients who take insulin typically gain weight, have significant risks of low blood sugars, and of course there’s the hassle of having to inject yourself with a medication as much as 5 times a day.”

The study’s findings could have several implications across broader healthcare policy and the healthcare field. Currently, many organizations are graded on the proportion of patients under a specific A1c level. A1c is a lab test that shows the average level of blood sugar in a patient over the previous three months.

However, Vijan said these approaches can be misguided because they encourage many patients to adopt treatments that cause more harm than benefit and providers to dictate treatment goals from a set standard, not a patient-centered approach.

“We need to move away from predetermining specific glucose goals for all patients,” he said. “The most effective approach is to simply sit down with patients and ensure that both the patient and provider understand both the likelihood that the patient will have any benefit from treatment, but more importantly that providers understand how patients feel about the burdens of the various treatment options.”