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"In this study, we found that, particularly among older patients and patients with serious chronic conditions, intensive treatment nearly doubled the risk of severe hypoglycemia requiring medical attention, including hospitalization," said lead author Dr. Rozalina McCoy. She is an endocrinologist at the Mayo Clinic in Rochester, Minn.
Hypoglycemia (low blood sugar) is a serious potential complication of diabetes treatment. The researchers said it can worsen quality of life and has been linked with cardiovascular events, dementia and death.
The researchers reviewed information from more than 31,500 American adults. All had stable and controlled type 2 diabetes. None was taking insulin. None had a prior history of severe hypoglycemia. Both of these factors are known to increase the risk for future hypoglycemia, the researchers explained.
Nearly 19 percent of older patients and those with serious chronic conditions (clinically complex patients) received intensive blood sugar management. More than 26 percent of non-complex patients received intensive treatment of blood sugar, the study authors reported.
Overall, older and clinically complex patients were nearly twice as likely to develop severe hypoglycemia as non-complex patients. Intensive treatment increased that risk by an additional 77 percent over two years, the researchers said.
"This means that 3 out of 100 older or clinically complex patients with [type 2] diabetes who never had hypoglycemia before, whose [blood sugar] is within recommended targets and who are not on insulin will experience a severe hypoglycemic episode at some point over two years," McCoy said in a Mayo news release.
"This does not even capture the more mild episodes of low blood sugar that patients can treat at home, without having to go to the doctor, emergency department or hospital," she added.
"These findings are concerning for many reasons," McCoy said. "Overtreatment results in greater patient burden, higher risk of medication side effects, and more severe hypoglycemia, which can lead to serious injury and even death. It adds more unnecessary costs for patients and the health care system."
McCoy stressed the need for providing individualized treatments for people with type 2 diabetes.
The study was published online June 6 in the journal JAMA Internal Medicine.
-- Robert Preidt
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