New research from Mayo Clinic finds that more than 2.3 million adult patients in the U.S. are likely being treated too intensively for their diabetes.
The researchers find this has caused thousands of potentially preventable emergency department visits and hospitalizations for hypoglycemia (low blood sugar).
The study team, led by Dr. Rozalina McCoy, 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.
Her team found that overly intensive glucose-lowering therapy — when patients receive more medication than is required based on their hemoglobin A1C level — was not only common across the U.S., but also directly contributed to 4,774 hospitalizations and 4,804 emergency department visits in a two-year period.
“Importantly, these numbers are a large underestimation of the true scope of overtreatment-induced hypoglycemic events,” says McCoy.
There are many reasons why people with diabetes may experience hypoglycemia.
McCoy explains that people who have multiple chronic health conditions are older, have Type 1 diabetes, or are treated with medications such as insulin or sulfonylureas are at highest risk.
“While some episodes of hypoglycemia may be unavoidable, especially if caused by unmodifiable risk factors such as the need for insulin therapy, others may be preventable, as in the case of overtreatment,” she states.
In an earlier study, her team separated out the effect of overtreatment from other high-risk factors and showed it was a significant independent contributor to hypoglycemic events.
In the present study, they wanted to learn more about the national scope of those overtreatment-related events.
“Because there is no U.S.-wide data about how many hypoglycemic events may be avoided if patients were treated less intensively, we had to separately calculate how many Americans are overtreated,” continues McCoy.
“We then used data from the earlier study, combined with this new data, to estimate the number of hypoglycemia-related emergency department visits and hospitalizations likely caused by overtreatment,” she explains.
While glucose-lowering medications reduce the risks of diabetes complications, such as cardiovascular disease, retinopathy, nephropathy, and neuropathy, McCoy emphasizes treatment plans must be evidence-based and individualized.
“It is important not only to ensure that we do not undertreat our patients with diabetes, but also that we do not overtreat them because both undertreatment and overtreatment can harm our patients,” she says.
McCoy says that the researchers found the study results alarming, with as many as 2.3 million Americans overtreated between 2011 and 2014. Moreover, clinically complex patients (those that were over the age of 75, had limitations on daily activities, had end-stage kidney disease and three or more chronic conditions) were intensively treated at a similar rate as patients who were not complex.
Historically, professional societies and regulatory bodies largely focused on reducing undertreatment and controlling hyperglycemia (high blood sugar).
McCoy hopes to see a shift to also include addressing and preventing overtreatment and hypoglycemia.
“We need to align treatment regimens and goals with each patient’s clinical situation, health status, psychosocial situation, and 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-focused — and for diabetes, specifically, glucose-focused — 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.”