Excerpt from an article
By Kasia Lipska
New York Times
Jan. 12, 2015

NEW HAVEN – ONE of my elderly patients has Type 2 diabetes and heart disease. He takes a number of medications, including insulin to control his blood sugar levels. A few years ago, he was driving when his blood sugar suddenly dropped. He felt lightheaded for a moment and then ran into a tree.

There are roughly 11 million Americans over age 65 with diabetes. Most of them take medications to reduce their blood sugar levels, The majority reach an average blood sugar target, or “hemoglobin A1C,” of less than 7 percent. Why? Early studies showed that this can reduce the risk of diabetes complications, including eye, kidney and nerve problems. As a result, for more than a decade, medical societies, pharmaceutical companies and diabetes groups have campaigned with a simple concrete message – to get below seven. Many patients carry report cards with their scores to clinic appointments. Doctors are often rewarded based on how many of their patients hit the target.

All of this sounds great. But, at least for older people, there are serious problems with the below-seven paradigm.

To begin with, the health benefits of this strategy are uncertain for older people. Those early studies that were the rationale for going below seven were conducted in people with Type 1 diabetes or with younger patients with newly diagnosed Type 2 diabetes. Subsequent trials of older patients raised doubts about the benefits.

Worse, targeting low blood sugar levels can cause harm. In one instance, investigators actually had to stop a trial early because patients who were targeting hemoglobin A1C levels of six or below had significantly higher rates of death than patients targeting levels in the sevens. We don’t know exactly why this happened. What we do know is that aiming for levels below seven increases the risk of “hypoglycemia,” or low blood sugar reactions. Severe reactions can result in confusion, coma, falls, fractures, abnormal heart rhythms and even death.

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