Maybe Tight Glucose Control Isn’t Needed in Older Diabetics

There’s a controversy amongst specialists as to whether tight glucose control is really a good thing in older, sicker diabetics. Some studies have even showed adverse outcomes with tight control. So University of Chicago physicians have studied the problem, and published their findings in the Annals of Internal Medicine.

The study was done using computer simulation to determine the effects of intensive glucose control in older, sicker patients. (This was done because such patients are normally excluded from clinical trials, so that there was insufficient data in the published literature.) By intensive treatment, the researchers simulated the treatment necessary to keep the HbA1c level to no more than 7%, compared with the easier target of 7.9%. They measured the anticipated average quality-adjusted days of life for subjects of different ages.

Healthy older patients of different ages had expected benefits of intensive glucose control ranging from 51 to116 quality-adjusted days. The worse the level of co-existing diseases, however, the expected benefits of tight control declined. For instance, the benefits conferred by tight control in a newly-diagnosed diabetic aged 60-64 declined from 106 when he was otherwise health down 8 days when he had a number of chronic ills.

This finding is really directed at physicians caring for old, sick, diabetics. The simulations show that there are diminishing returns for intensifying glucose control towards ideal levels when the general condition of the patient is poor. But the results may also comfort those caregivers who balk at disturbing their patients to do blood frequent glucose tests, or deny them favorite foods.