HEALTH: Some Older Patients Are Treated Not Wisely, but Too Much - nytimes

Over many years, the 77-year-old patient has managed to control his Type 2 diabetes. Thanks in part to daily doses of a drug that reduces blood sugar, his glucose level is a very low 6.5 percent.

Like a lot of older people, he copes with multiple medical conditions, including high blood pressure and severe kidney disease. But with four prescription drugs, plus Tylenol for lower back pain, he’s doing reasonably well.

Oh, and he’s a hypothetical example, concocted by researchers at the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System. They sent this fictional case study to primary-care professionals at Veterans Affairs medical centers across the country and asked a series of questions about the man’s treatment.

The researchers believed their nearly 600 respondents — mostly physicians, but alsonurse practitioners and physician assistants — would recognize that such a patient risked developing dangerously low blood sugar, called hypoglycemia. But no. About half these professionals said they wouldn’t worry about potential harm from the man’s rigorous treatment regimen.

Evidence is accumulating that older adults with diabetes, hypertension and other conditions should be treated less aggressively than they commonly are. “Deintensification,” the Michigan researchers have named this approach.

As this and another related recent study have shown, not for the first time, getting that message out to practicing physicians has proved difficult.

Under current guidelines, most older patients with diabetes don’t have to get their blood sugar to rock bottom; a 7.5 or 8 percent HbA1c (an average measure of recent blood glucose control) produces the same benefits as very low glucose.

Blood pressure readings, too, should be allowed to rise as patients age — up to 150 millimeters of mercury for systolic pressure. The previous goal was to keep it below 140. - Read More at NYT

Some Older Patients Are Treated Not Wisely, but Too Much