Only a third of older adults with diabetes meet guidelines set by the American Diabetes Association for controlling the disease, new research shows.
And even when less stringent guidelines are used, many older Americans aren’t doing a very good job of managing their diabetes, which could lead to nasty complications, including blindness, heart attack or stroke and amputations, down the road.
Researchers at the Johns Hopkins Bloomberg School of Public Health in Maryland found significant racial disparities, particularly among women, in diabetes control. Older black women, they found, are much less likely to reach suggested guidelines for blood sugar, blood pressure and cholesterol levels. All three measures are crucial in managing diabetes and preventing complications.
Overall, the study published in the July issue of Diabetes Care suggests much work needs to be done to help adults 65 and older better manage the disease, researchers say. But the findings also raise questions about how valuable broad guidelines for blood sugar and blood pressure control are for older Americans. The real question, study authors say, is whether the benefits of lowering blood sugar and blood pressure in the elderly outweighs the risks associated with the potentially serious side effects associated with the medications used to treat those conditions.
“There is tremendous debate about appropriate clinical targets for diabetes in older adults, particularly for glucose control. Are some older adults being over-treated? Are some being undertreated? These are questions for which we don’t have answers,” study leader Elizabeth Selvin, PhD, MPH, a professor of epidemiology at the Bloomberg School, said in a university press release.
The researchers looked at three different measures key to good diabetes control ““ hemoglobin A1C (which measures blood glucose levels), blood pressure and LDL cholesterol. The American Diabetes Association guidelines call for hemoglobin A1C levels below seven percent, blood pressure under 140/90 mmHg and LDL cholesterol under 100 mg/dL. While 72 percent met the hemoglobin A1C level, 73 percent met blood pressure goals and 63 percent had good cholesterol levels, only 35 percent met all three targets.
Older people with diabetes are more likely to be sick with other diseases on top of their diabetes and those other illnesses may need more immediate attention from doctors, said study co-author Christina M. Parrinello, PhD, MPH. Many of the complications associated with poor diabetes management – kidney disease, blindness and nerve damage – take a long time to appear, she said.
If patients over 65 are over-treated – say, their blood pressure goes too low or their glucose levels drop too sharply – they are at risk of losing consciousness, falling and other medical problems.
“There is a question in this field of how much good we are doing as opposed to harm when we try to tightly control diabetes in older people, because the treatments are not benign in older adults,” Parrinello said. “If the primary benefit of glucose control, for example, is to prevent kidney, eye and nerve damage – complications that take 10 to 20 years to develop – maybe it doesn’t make sense to focus on glucose control in certain patients where diabetes may be the least of their concern.”
More research is needed to determine what the best control targets are in an older population. The researchers say that each patient needs to be carefully considered individually.
