Very Elderly Patients May Benefit From Stopping Diabetes Medicines

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Can diabetes medication be reduced in elderly patients? An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control, by Peter Sjoblom and colleagues. Diabetes Research and Clinical Practice 82:197-202, 2008

What is the problem and what is known about it so far?

Most of the information we have about drugs for type 2 diabetes comes from studies of patients younger than 70 years of age. However, the risk for developing diabetes increases with age, and 15 to 20 percent of people older than 80 have diabetes. In general, diabetes management calls for controlling blood glucose levels as much as possible to prevent complications. But there are no studies showing that this is the best approach in the oldest patients. Because body functions decline with age, very old patients may be more likely to have drug reactions or to have low blood glucose from diabetes drugs.

Why did researchers do this particular study?

The researchers wanted to learn more about blood glucose control in elderly patients in nursing homes and to find out whether reducing or stopping diabetes medicines can be done safely in those who have tight blood glucose control.

Who was studied?

The study included 32 type 2 diabetic patients in 17 nursing homes in Sweden. The patients had A1C levels (a measure of one's blood glucose levels over a few months) equal to or less than 6%, which means their diabetes was in very tight control.

How was the study done?

Researchers measured patients' glucose levels for 3 days in a row and then stopped or reduced diabetes pills and insulin. They then monitored patients' A1C levels 3 and 6 months later.

What did the researchers find?

Among the 32 patients, researchers identified 31 low blood glucose events, mostly at night, during the three initial days of monitoring. Patients whose diabetes drugs were reduced or stopped continued to have A1C levels less than 6% even after 6 months.

What are the limitations of the study?

The patients whose medicines were stopped or reduced were compared to patients with different characteristics, including higher A1C levels at the start of the study. A better comparison would have been to others with comparable A1C levels whose medicines were not halted or reduced. The study results only apply to very old, frail patients with type 2 diabetes in nursing homes. The study defined low blood glucose only by laboratory glucose measurements and not by symptoms or other factors.

What are the implications of the study?

Low blood glucose events are common in very elderly patients with type 2 diabetes. Very elderly patients who are frail and often have other health problems could be harmed by low blood glucose events, especially if their blood glucose control is already tight. Reducing or stopping diabetes medicines in very elderly, frail patients with good glucose control is safe and may lower their risk for harm from low blood glucose events.

FOR MORE INFORMATION

Hypoglycemia (low blood glucose)

Tight diabetes control

Diabetes: A Guide to Living Well