How aggressively should doctors treat type 2 diabetes?
A new study published last Monday in JAMA Internal Medicine could help patients and their doctors navigate the difficult decision of how aggressively to bring down blood sugar levels with medication. It used computer modeling to determine that patients over age 50 with mild to moderate type 2 diabetes — defined as having a hemoglobin A1C level of less than 9 percent — likely get a net negative effect from using insulin because their risks of developing severe diabetes complications like blindness or kidney disease are small.
The American Diabetes Association recommends that doctors try to get patients’ hemoglobin A1C levels — a blood test used to monitor blood sugar levels in diabetes patients — down to about 7 percent using drugs, if lifestyle counseling doesn’t work. But many endocrinologists who treat diabetes now believe that’s an over-simplified recommendation.
Dr. David Erani, director of medical programs at Joslin Diabetes Center, said, “A patient with a low A1C who is having frequent severe hypoglycemia would be better off without the hypoglycemia even if it means accepting an A1C which is higher than ideal.”