The new retrospective cohort study published in the journal JAMA Internal Medicine suggests that patients and doctors should work together to cut back on medication used for lowering blood pressure and blood sugar. The research team from the University of Michigan Medical School and VA Ann Arbor Healthcare System found that only one in four of about 400,000 older adults who could have been eligible to cut back on their multiple blood sugar or blood pressure drugs actually had their medications lowered.
âAs people get older, the risks of overtreating become greater, and the benefits become shorter,â explained lead study author Dr. Jeremy Sussman. âWe have to start emphasizing that more isnât always better. Overtreatment is work, and people are being asked to work hard for something thatâs counterproductive.â
He adds that failing to lower medication when it is necessary wastes money and produces an outcome that is not healthy.
The study included 211,667 diabetic patients older than the age of 70 who received blood pressureâlowering drugs or blood sugarâlowering drugs between January 1 and December 31, 2012. The research team analyzed data from December 10, 2013 to July 20, 2015.
The researchers found that 27% of the 12,917 patients taking blood sugarâlowering drugs had their medications decreased. Overall, 179,991 patients were treated for diabetes. In 143,305 patients with normal blood sugar levels, 17.5% had their medications reduced. In 23,769 patients with moderately low blood sugar levels, about 21% had their medications reduced.
Among the 104,486 patients with normal low pressure, only 15.1% had their medications decreased. OfÂ 25,955 patients with moderately low blood pressure, 16% had their medication decreased. Among 81,226 patients with very low blood pressure levels, only 18.8% had their blood pressure medication reduced.
In a survey from the same researchers, about half of 600 physician assistants, nurse practitioners, and doctors said they would lower the medication, in a hypothetical scenario, of a 77-year-old diabetic at risk of hypoglycemia. A third of the healthcare providers believed that their patients may benefit from overtreatment. About 25% were concerned about a lawsuit from treatment reduction, and about 50% were worried that lowering medications in patients who had researched the drugs would lower performance scores on their clinical âreport card.â The survey also found that another 20% of the healthcare providers were worried that reducing the medication would upset the patients.
Sussman also noted that doctors tend to prescribe drugs to control blood pressure and to focus on the long-term health of their patients. Control of these factors can cut a patientâs risk of other problems linked with high blood sugar or blood pressure levels, including blindness, kidney failure, nerve damage, heart attack and stroke.
âEvery guideline for physicians has detailed guidance for prescribing and stepping up or adding drugs to control these risk factors, and somewhere toward the end it says âpersonalize treatment for older people.’ But nowhere do they say actually stop medication in the oldest patients to avoid hypoglycemia or too-low blood pressure.â
It can be hard to recognize the signs of too-low blood pressure or blood sugar. Checking blood sugar levels daily and taking multiple medications can be difficult for many seniors. On the other hand, reducing treatment will often provide relief.
Sources for Todayâs Article:
Sussman, J.B., et al., âRates of Reintensification of Blood Pressure and Glycemic Medication Treatment Based on Levels of Control and Life Expectancy in Older Patients With Diabetes Mellitus,â JAMA Internal Medicine 2015, doi: 10.1001/jamainternmed.2015.5110.
Gordon, S., âToo Many Seniors With Diabetes Are Overtreated, Study Suggests,â MedicineNet.com, October 29, 2015; http://www.medicinenet.com/script/main/art.asp?articlekey=191516.
Lipska, K.J., et al., âPotential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control,â JAMA Internal Medicine 2015; 175(3): 356â362, doi: 10.1001/jamainternmed.2014.7345.
âToo much, too late: Doctors should cut back on some medications in seniors, two studies suggest,â ScienceDaily web site, October 26, 2015; http://www.sciencedaily.com/releases/2015/10/151026112220.htm.