Overtreatment of insulin and sulphonylureas appears to be common in elderly people with type 2 diabetes, including those with chronic kidney disease or dementia, according to new UK research.
Insulin and sulphonylurias are medications which aggressively lower blood sugar levels and therefore overtreatment can lead to hypoglycemia (too low blood sugar levels).
The study was carried out by researchers at Leicester Diabetes Centre and the University of Leicester. Data was drawn from a database of 24,661 people from 16 GP surgeries across Norfolk
Of these, 1,379 met the criteria of being 70 years old or older, having type 2 diabetes and being prescribed either a sulphonylurea drug or insulin. 644 participants had chronic kidney disease (CKD) and 60 had dementia.
The analysis showed that 30 per cent of the participants had HbA1c values below 53 mmol/mol (7%). The researchers defined this to be ‘potential overtreatment’ of diabetes.
When the researchers stratified the results by prescription, they found the following proportions of people that were being potentially overtreated:
On sulphonylureas: 35 per cent of participants
On insulin: 24 per cent of participants
On a combination of sulphonylureas and insulin: 16 per cent
The researchers concluded that overtreatment of type 2 diabetes in elderly people was common, even within people with CKD and dementia. The researchers have noted in the study that it is ‘potential overtreatment’.
It should also be noted that some people with type 2 diabetes may lose the ability to produce sufficient insulin as a result of having uncontrolled type 2 diabetes for many years. In these people, insulin therapy may be necessary.
In terms of sulphonylureas, there are questions whether their usage, or the dose being used, is appropriate as these drugs can lead to hypoglycemia. This can be particularly problematic in people that have conditions such as CKD and dementia.
The study is published in the Diabetic Medicine journal.