December 10, 2013
News Review From Harvard Medical School -- Hypoglycemia Increases for Older Diabetics
Rates of heart disease, strokes and limb amputations are down sharply among older adults with diabetes today, compared with the 1990s, a study finds. But now hypoglycemia (episodes of low blood sugar) is one of the top problems for this group. Researchers said doctors may need to adjust drug doses as people get older in order to prevent low blood sugar. The study included more than 72,000 adults age 60 or older. They were all patients of the same managed care system. Cases of heart and blood vessel disease increased with age, and with how long people had diabetes. Overall, though, heart problems were only about one-seventh as common as another study found in the 1990s. Dangerous levels of high blood sugar and amputations also declined. But in the new study, low blood sugar became a more common problem among those who had diabetes longer. For people who had the disease at least 10 years, low blood sugar tied with heart and blood vessel disease as the most common problem. The journal JAMA Internal Medicine published the study. HealthDay News wrote about it December 10.
By Lori Wiviott Tishler, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
We have almost 12 million people with diabetes over the age of 60 in the United States. In the next 20 years, that number is expected to double.
This study provides important information for older adults with diabetes. It's also useful for their doctors and for public health officials and policy makers.
Study authors used data from more than 72,000 adults age 60 and older. All of them had type 2 diabetes. They also were enrolled in a single health system.
The best news, overall, is that further health problems related to diabetes have greatly decreased over the years -- even for older people. That's because treatment is so much better!
The study found that:
- For patients who had diabetes for less than 9 years, the most common problems (complications) were:
- Heart conditions
- Eye problems
- Hypoglycemia, or low blood sugar
- For people who had diabetes for more than 10 years, the order changed:
- Low blood sugar and heart conditions (a tie)
- Eye problems
This information is very important for doctors and patients. Together, motivated patients and their doctors can work toward reducing the risks of heart and eye disease.
As our policy makers set targets for quality measures, they can also take into account the special issues for older adults. Thus, they can set targets (for blood sugar, for example) that are rational, relevant and safe.
What Changes Can I Make Now?
Find out if you have diabetes! Are you age 60 or older? Do you have any of the factors that increase the risk of type 2 diabetes? Besides age, these include:
- Having a family history of diabetes
- Being overweight
- Not exercising
- Having high blood pressure
- Having low levels of HDL (the "good" cholesterol)
- Having African-American, Hispanic, Native American, Asian or South Pacific Island racial heritage
- Having a history of diabetes during pregnancy
- Having a baby who weighed nine pounds or more
If you have any of these risk factors -- and many of us do -- then talk with your doctor. A test can show whether you have diabetes.
If you are at least 60 and you have diabetes, then work with your doctor to decrease your risk of heart and eye disease. Make sure that your cholesterol and blood pressure are well controlled. Control your blood sugar. See your eye doctor at least once a year -- more if necessary.
Hypoglycemia, or low blood sugar, is a special risk for people with diabetes. If your sugars go too low because of treatment, you could fall, have a car accident or even a seizure. It's important to:
- Keep track of your blood sugar
- Make sure you and your family know the signs of low blood sugar
- Treat low blood sugar right away to avoid the risks
This study suggests that if you have had diabetes for more than 10 years, you might be at greater risk of low blood sugar. Therefore, your treatment should account for that risk.
What Can I Expect Looking to the Future?
Data presented in studies like these can really help doctors to tailor care to each person. We can target treatment better to people based on what we've learned. We can work better toward goals for the entire population as well. I hope that we will see more well-done studies that will help us to think about critical treatments for different populations.