Intensive Blood Glucose Control Limited by Co-morbidities in Older Adults
Age, by itself, is not an indicator for limiting tight glucose control according to a recent study. What limits the control parameters for older adults with type 2 diabetes is functional impairment and their list of co-morbidities. Chronological age, the study states, is not an indicator for abandoning tight control.
Intensive control of type 2 diabetes has met with mixed results according to recent studies such as the ACCORD and ADVANCE trials (http://www.reuters.com/articlePrint?articleId=USN0640739920080606). Both trials failed to show any reduction in cardiovascular events over 3.5-5 years in high risk patients with type 2 diabetes treated with intensive blood glucose lowering strategies, compared with standard treatment. The ACCORD trial was stopped early due to a higher incidence of all cause death in the intensive arm. ADVANCE found a statistically significant absolute risk reduction of 1.5% in major microvascular events over 5 years for the intensive treatment group primarily due to a reduction in nephropathy. Their results support current NICE (http://www.nice.org.uk/)
advice against highly intensive blood glucose management targeting lower than recommended levels in type 2 diabetes.
This study used a decision analysis design to determine that patients aged 60-80 years old placed in either an intensive or moderate glycemic model had benefits from intensive treatment. When the impairments and co-morbidities were factored in the benefits progressively decreased.
The authors concluded that while intensive treatment may be beneficial and age alone does not preclude such treatment, the impact of other illnesses and functionality do impact. These results, according to the authors of this study, support relaxing blood glucose control in elderly patients with co-morbidities.
Kathy Shattler received her Master of Science degree from Michigan State University in E. Lansing Michigan in Human Nutrition. Her twenty-two years of practice includes holding positions as a Lecturer, Chief Clinical Dietitian and Program Manager. Kathy is the Founder of Nutri-Care Consulting and is currently the Nutrition Director of www.CEU4U.COM, an online continuing education management company for Registered Dietitians and Dietetic Technicians.
