Overly Strict Blood Sugar Control Can Be Risky for Elderly Diabetics, Experts Warn
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Aggressive blood sugar management in older adults may lead to serious side effects, including hypoglycemia, according to recent reports. Experts, including those at the University of California, San Francisco Campus, and seoul National University Hospital, are advocating for a more balanced approach to diabetes care for the elderly. The New York Times recently highlighted the potential risks of overly strict blood sugar control in this vulnerable population.
Rethinking Glycemic Targets for Seniors
For years, the standard advice for diabetics has been to maintain a glycated hemoglobin (HBA1C) level of less than 7%. However, the American Geriatrics Society suggests a more lenient target for the elderly, recommending a range of 7.5-8%. In cases where elderly individuals have multiple chronic diseases or a limited life expectancy, even higher levels, up to 8-9%, may be acceptable.
This shift in viewpoint acknowledges that the benefits of strict blood sugar control may not outweigh the risks for older patients. While younger and middle-aged individuals benefit from long-term prevention of diabetes complications, such as myocardial infarction, stroke, vision and hearing loss, chronic kidney disease, and amputations, elderly patients may not live long enough to reap these rewards.
Strict blood sugar control is very vital at age 50, but it is less significant in the case of the elderly.
Seyi Lee, University of California, San Francisco Campus
The timeline for seeing tangible health improvements from rigorous blood sugar management can be considerable, making it less impactful for those with shorter life expectancies.
The Risks of Hypoglycemia
A primary concern with strict blood sugar control in the elderly is the increased risk of hypoglycemia, a condition where blood sugar levels drop to low. This is notably common among diabetes patients using blood sugar-lowering agents.
Hypoglycemia can manifest in various ways, from mild symptoms like sweat, anxiety, and fatigue to severe consequences such as loss of consciousness, confusion, and an elevated risk of accidents. In extreme cases, delayed treatment of hypoglycemic shock can lead to brain damage, with the risk escalating with age.
If you have had diabetes for a long time, you are likely to have experienced hypoglycemia.
Seyi Lee, University of California, San Francisco Campus
The prevalence of hypoglycemia in elderly care settings is a notable concern.
The most common diabetes treatment is caused by nursing homes.
Dr. Joseph Outslander, editor of the Journal of the Elderly Society of the American society of Elderly
Dr. Outslander suggests that the actual number of patients experiencing hypoglycemia might perhaps be even higher than reported.
Balancing Blood Pressure Management
Similar considerations apply to blood pressure management in the elderly.Lee Hae-young, a professor of internal medicine at Seoul National university Hospital, advocates for a gradual approach to lowering blood pressure in older patients.
In the guidelines for high blood pressure management guidelines, the elderly supports ways to slow down blood pressure control. It is indeed desirable to find a balance by shortening it, rather than breaking all of the medicine.
Lee Hae-young, professor of internal medicine at Seoul National University hospital
A study analyzing the effects of blood pressure control in elderly patients in the U.S. and China revealed that cardiovascular disease incidence could be reduced by over 20% within four years. This indicates that even relatively short-term blood pressure management can yield significant benefits for the elderly.
A study that analyzed the effect of blood pressure control for elderly patients in the US and China showed that the incidence of cardiovascular disease is reduced by more than 20% for four years. In the elderly, blood pressure management can have a significant effect even in a relatively short three to four years, not for more than 10 years.
Lee Hae-young, professor of internal medicine at Seoul National University Hospital
Rethinking Diabetes Management: Is Strict Control Always Best for Seniors?
“Teh relentless pursuit of ultra-low blood sugar levels in older adults with diabetes might actually be doing more harm than good,” states Dr. Evelyn Reed, a leading geriatrician specializing in diabetes management.
World-Today-News.com Senior Editor (WTN): Dr. Reed, recent reports suggest that overly aggressive blood sugar control can be detrimental to elderly diabetics. Could you elaborate on this concerning trend?
Dr. Reed: Absolutely. For years, the focus has been on achieving a very low glycated hemoglobin (HbA1c) level—typically under 7%—for all diabetic patients, regardless of age. Though, we’re now understanding that this approach might potentially be too stringent for older adults. The risks associated with achieving such tight glycemic control, particularly the heightened risk of hypoglycemia, often outweigh the potential long-term benefits for individuals with limited life expectancy. A more balanced approach,focusing on minimizing complications and maximizing quality of life,is crucial for this population.
WTN: Can you clarify what constitutes a “balanced” approach to blood sugar management in elderly diabetics? What should their glycemic targets be?
Dr. Reed: A balanced approach prioritizes individual patient needs and considers their overall health status, comorbidities, and life expectancy. The American Geriatrics Society, as an example, suggests a more lenient HbA1c target of 7.5-8% for many seniors. In cases of multiple chronic conditions or limited life expectancy, a range of 8-9% may even be acceptable after careful consideration and discussion with the patient’s physician. This is because the potential benefits of achieving near-perfect glucose control may not offset the risks of hypoglycemic episodes and other treatment side effects. remember, the goal is to improve quality of life and prevent notable complications, not necessarily to maintain perfect numbers.
WTN: Hypoglycemia is a significant concern. Can you detail its potential impact on elderly patients and its effect on their overall health?
Dr. Reed: Hypoglycemia,or dangerously low blood sugar,is a serious threat,especially to older adults. The symptoms can range from mild—sweating, shakiness, confusion—to severe—loss of consciousness, seizures, and even death due to hypoglycemic shock. For elderly patients, the risk of falls and other accidents increases considerably during hypoglycemic events. Moreover, the brain’s vulnerability to hypoglycemic damage also increases with age. In nursing homes, the prevalence of hypoglycemia is a worrisome fact, frequently enough due to medication regimens or difficulties managing blood glucose levels promptly. it is an under-recognized and under-reported phenomenon. This demonstrates the need for increased awareness and better risk assessment.
WTN: What about blood pressure management in older adults? Does a similar principle apply?
Dr. Reed: Indeed.For elderly patients, aggressively lowering blood pressure may also present more risks than benefits. A gradual approach, tailored to the individual’s health profile, may be more appropriate.The focus should be on preventing significant cardiovascular events like strokes rather than solely pursuing the lowest possible blood pressure reading. Finding a balance between effective blood pressure control and minimizing the risk of adverse effects is paramount. Studies have shown that even moderate reductions in blood pressure can yield significant benefits in terms of cardiovascular health within a relatively short timeframe, even just 3 to 4 years. The emphasis here is on gradual improvement, not swift, radical changes.
WTN: What are the key takeaways for both patients and healthcare providers regarding diabetes and blood pressure management in the elderly?
Dr. Reed: For healthcare providers, It’s essential to:
Individualize treatment plans: Recognize that a “one-size-fits-all” approach doesn’t work for elderly adults.
Prioritize quality of life: Balance the benefits of strict glucose and blood pressure control with the risks of complications and adverse events.
Educate patients and their families: Equip them to understand the risks and benefits—and to actively participate in their care.
Regular monitoring: closely monitor blood sugar and blood pressure levels to ensure safety and adjust treatment as needed.
For patients and their families, remember to:
Open Communication: Discuss specific concerns and goals with your doctor.
Active participation: Take an active role in your treatment, understanding both benefit and risk.
Symptom Awareness: Learn to recognize the signs and symptoms of hypoglycemia.
Lifestyle modifications: Incorporate lifestyle modifications like regular exercise and a healthy diet to improve overall health.
WTN: Thank you, Dr. Reed, for providing such valuable insight. Your advice highlights the importance of tailored care, avoiding unnecessary risks for the elderly and emphasizing a realistic approach focusing on quality of life. readers, please share your questions and experiences in the comments below, and let’s continue this crucial conversation on social media.