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The Dangers of Overtreating Diabetes

The Dangers of Overtreating Diabetes

Historically, preventing hyperglycemia (increased sugar levels) is the most pressing concern in treating diabetes. Now, there seems to be a paradigm shift. Studies show that many patients are receiving overly intense treatment to the point that it’s become harmful. What are the dangers of overtreating diabetes?

Diabetes: Everything you need to know

What is “Diabetes Overtreatment”?

Diabetes overtreatment happens when patients receive “overly intensive glucose-lowering therapy”.

It’s important to remember that sometimes, hypoglycemia may still occur even with a controlled insulin regimen. Hypoglycemia can happen when:

  • there is no regular medical check-ups or follow-ups
  • patients who, while on their current insulin regimen, get sick/ have an infection
  • patients who changed their eating habits/are eating less/ working out more, etc. but still have not consulted with their doctor regarding the need for changes in their dosing regimen.

Mayo Clinic’s primary care physician and endocrinologist Rozalina McCoy, MD, explains that this usually happens when a diabetic receives more medications that what was required based on their hemoglobin A1C level.

The Importance of HA1C Testing

In the Philippines, it’s common for people to assume that someone is diabetic by merely looking at their fasting blood sugar results. However, doctors don’t rely on that test alone. To check for prediabetes or diabetes, they may also use the hemoglobin A1C (HA1C) testing.

Unlike common blood sugar tests that measure the glucose level at the moment, HA1C is different. It checks for the average amount of sugar attached to your hemoglobin (oxygen-carrying component of the red blood cell) over the past 3 months.

A normal HA1C result reads below 5.7%. Prediabetes is 5.7% to 6.4% while 6.5% or higher may denote diabetes.

Severe Hypoglycemia – The Dangerous Result of Overtreatment

The main and most concerning danger of overtreatment is severe hypoglycemia.

Hypoglycemia happens when a diabetic person suffers from very low blood sugar levels. The truth is, the dangers of overtreating diabetes most center on the symptoms of extremely low sugar levels:

  • Dizziness
  • Shakiness
  • Blurred vision
  • Anxiety
  • Muscle weakness
  • Seizures
  • Confusion

Sometimes, it also leads to accidents, such as falls, that may severely hurt the patient if they hit their head on a hard or pointed surface.

Finally, don’t forget that extreme hypoglycemia can also be fatal.

As of now, there are already thousands of documented cases wherein a patient needed to visit the emergency room or stay in the hospital because of their overly intensive glucose-lowering therapy.

What Is Diabetic Ketoacidosis?

Overtreatment is Common, a Study Finds

Dr. McCoy and her team used the data from the 2011-2014 National Health and Nutrition Examination Survey to determine how many Americans received overtreatment. Surprisingly, they found out that the dangers of overtreating diabetes are common.

They discovered that out of the 10.7 million adult participants with diabetes (none of whom were pregnant), 22% or approximately 2.3 million patients receive overly intense treatment.

The study identifies an “intensely treated” patient as someone who received medication to ensure that their HA1C level is normal (5.6% or lower).

A diabetic also receives intense treatment if they take 2 medications to keep their blood glucose levels in the prediabetes range.

the dangers of overtreating diabetes

The Patterns of Overtreatment

In a separate study published in the Journal of General Internal Medicine, the researchers analyzed the data from more than 78,000 participants with diabetes.

They found out that 11% of the participants had a “very low on-going blood sugar level”. This finding suggests that these patients were overly treated. However, only 14% of that subgroup had a “reduction” in their medication refills 6 months after the reading.

The investigators likewise noted that patients 75 years old and above, and those who qualified for state and federal health coverage, were more likely to be overtreated.

The problem with this particular finding is that patients aged 75 and older are considered “clinically complex”.

Who Are the Clinically Complex Patients?

The dangers of overtreating diabetes could be more prominent in clinically complex patients.

According to Dr. McCoy, clinically complex patients are not just less likely to benefit from intense treatment, but they are also more prone to hypoglycemia.

Aside from being at least 75 years old, patients can also be considered clinically complex if they have:

  • Two or more limitations in performing their activities of daily living. For example, they have difficulty in dressing, eating, walking, etc.
  • An end-stage renal disease.
  • Three or more chronic conditions.

Alarmingly, in the Mayo Clinic study headed by Dr. McCoy, they noticed that being in the clinically complex category didn’t come into play on whether or not a person was intensely treated.

In other words, it was possible for a clinically complex patient to still receive intense treatment, even though they might not benefit from it and it even might heighten their risk of severe hypoglycemia.

the dangers of overtreating diabetes

Strategies in Preventing the Dangers of Overtreating Diabetes

When a person has diabetes, it’s normal for healthcare providers to do their best to avoid undertreatment and manage hypoglycemia. However, Dr. McCoy emphasizes that overtreatment and hypoglycemia must also be addressed.

She said that one of the most important things that can be done to ensure proper care is to shift the focus from the disease to the person. This means that any treatment regimen should be aligned to the patient’s clinical situation and not just the disease.

For instance, why not consider “softening” the target HA1C levels?

Most treatment regimens – regardless of the patients’ situation – aim for HA1C levels of less than 7%. This is because that level seems to be beneficial in slowing down the progression of some diabetes complications.

However, there are pieces of evidence suggesting that the benefits it offers are just “modest” at best. And sometimes, it even decreases the patient’s quality of life.

This is the reason why some doctors express the possibility of softening the target to about 7.9 to 8.4 %.

Communication with the Doctor is Crucial

Now that you know about the dangers of overtreating diabetes, it’s time to take a more pro-active role in managing your condition.

Don’t hesitate to have a long discussion with your doctor, especially if you are under the clinically complex patient category. Talk to them about how your treatment can consider factors such as your age, any physical disability, or your quality of life.

Learn more about Diabetes here.

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Sources

Hemoglobin A1C (HbA1c) Test
https://medlineplus.gov/lab-tests/hemoglobin-a1c-hba1c-test/
Accessed September 28, 2020

Study: Many Older Diabetes Patients May Be Dangerously Overtreated
https://labblog.uofmhealth.org/rounds/study-many-older-diabetes-patients-may-be-dangerously-overtreated
Accessed September 28, 2020

Too much of a good thing can be dangerous, finds researchers investigating hypoglycemia
https://www.sciencedaily.com/releases/2019/08/190815092042.htm
Accessed September 28, 2020

Experts urge use of evidence-based medicine to avoid overtreatment of type 2 diabetes
https://www.sciencedaily.com/releases/2017/01/170131145645.htm
Accessed September 28, 2020

Five Strategies to Avoid Diabetes OverTreatment
https://www.endocrineweb.com/professional/diabetes-complications/preventing-diabetes-overtreatment-5-strategies-evidenced-based-c
Accessed September 28, 2020

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Written by Lorraine Bunag, R.N. Updated May 18
Medically reviewed by Mia Dacumos, M.D.
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