A new study published in JAMA Internal Medicine found that over 20% of patients with type 2 diabetes were given intensive treatment that was potentially unnecessary and may have increased their risk of severe hypoglycemia.
Currently, treatment guidelines recommend a target HbA1c level <7.0% for most non-pregnant adults with type 2 diabetes. Those with older age, shortened life expectancy, and complex health conditions, however, may actually be harmed from the tight glycemic control.
Rozalina G. McCoy, MD, of Mayo Clinic, Rochester, MN, and colleagues retrospectively analyzed administrative claims data in 31,542 adults to examine the prevalence of intensive treatment and the association between intensive treatment, clinical complexity, and incidence of severe hypoglycemia in adults with type 2 diabetes who were not using insulin. Non-pregnant adults aged 18 years and older with type 2 diabetes who achieved and maintained HbA1c <7.0% without insulin use and without episodes of severe hypo- or hyperglycemia in the past 12 months were included.
Intensive treatment was defined as use of more glucose-lowering agents than recommended at specific index HbA1c levels. Ambulatory, emergency department, and hospital claims data were used to identify severe hypoglycemia during the 2 years after the index HbA1c test. In addition, patients were categorized as having high vs. low clinical complexity if they were ≥75 years, had dementia or end-stage renal disease, or had ≥3 serious chronic conditions.
The data showed a risk-adjusted probability of intensive treatment of 25.7% (95% CI: 25.1%–26.2%) in patients with low clinical complexity and 20.8% (95% CI: 19.4%–22.2% in patients with high clinical complexity. The risk-adjusted probability of severe hypoglycemia during the following 2 years in patients with low clinical complexity was 1.02% (95% CI: 0.87%–1.17%) with standard treatment and 1.30% (95% CI: -0.10%–0.66%) with intensive treatment. In patients with high clinical complexity, intensive treatment significantly raised the risk-adjusted probability of severe hypoglycemia from 1.74% (95% CI: 1.28%–2.20%) with standard treatment to 3.04% (95% CI: 1.91%–4.18%) with intensive treatment (absolute difference, 1.30%, 95% CI: 0.10%–2.50%).
For patients with high clinical complexity, “intensive treatment nearly doubles the risk of severe hypoglycemia,” noted Dr. McCoy. The study authors concluded that individualized assessment of clinical complexity and the consideration of risks and benefits are important in patient-centered diabetes management.
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