Medicare Patients With Diabetes at Risk of Overtreatment
More Medicare recipients are overtreated than undertreated for diabetes, yet rarely have their regimens been scaled back or deintensified, leaving them at increased risk of potentially life-threatening complications, say researchers.
Analysis of claims data and prescription refills from 78,792 Medicare recipients with diabetes in 10 states shows that 8560 (10.9%) were potentially overtreated compared with 6.9% who were potentially undertreated, according to Matthew L Maciejewski, PhD, of Duke University and Durham Veterans Affairs Medical Center, NC, and colleagues, reporting in the Journal of General Internal Medicine.
Only 14% of those who were overtreated were taken off previously recommended treatments, the study authors say.
Major trials have shown that in older patients and in those with comorbidities, aggressive diabetes control carries substantial risks.
Severe hypoglycemia, cardiovascular events, cognitive impairment, fractures, and death associated with overtreatment of diabetes “can happen at any time,” note Dr Maciejewski and colleagues.
Optimizing glucose control is clinically difficult, but it is a public-health imperative.
Over-75s Most Likely to Be Overtreated
To compare the rates and patient characteristics associated with overtreatment and undertreatment of diabetes in the same cohort of patients, the researchers examined records for Medicare patients with at least one HbA1c lab result available between January 1, 2011, and June 30, 2011.
Patients with an HbA1c of < 6.5% at a single point in 2011, with fills for any diabetes medications beyond metformin, were considered potentially overtreated; those with HbA1c > 9% were considered undertreated.
Individualize Treatment to Maximize Care While Avoiding Unnecessary Harm
Effective treatment of diabetes requires a major shift toward individualized treatment, and this study will help identify those who may benefit from more intensive treatment as well as those who may need less, they explain.
By focusing at both the overtreatment and undertreatment ends of the diabetes quality spectrum, we can best begin to truly improve the quality of diabetes care, ensuring that patients get needed care while avoiding unnecessary potential harm.
Several major studies as well as new clinical guidelines for diabetes management have followed with recommendations for relaxed glycemic-control targets in older adults with multiple chronic conditions, limited life expectancy, diabetic complications, or functional impairment.