Overtreating Diabetes Can Cause Hypoglycemia, Study Finds

Older patients and those with other complications are at greatest risk.

When it comes to type 2 diabetes (T2D), there can be too much of a good thing, a new study finds.

Overtreating T2D—and driving blood sugar too low—can cause hypoglycemia, causing people to faint, have seizures or even go into a coma, according to a study publishes in JAMA Internal Medicine.

Rosalina McCoy, MD, MS, and colleagues from the Mayo Clinic reviewed 13 years’ worth of claims’ data for more than 31,000 people with T2D. These patients had achieved and maintained a glycated hemoglobin (A1C) of 7.0% or lower without insulin without an incident of severe hypoglycemia over the previous 12 months.

They categorized the patients by disease complexity and scrutinized those who were receiving intensive treatment, which was defined as using more glucose lowering therapies than called for in practice guidelines given the patient’s A1C level.

The risk-adjusted probably of such treatment was 25.7% in patients with low clinical complexity and 20.8% in patients with high clinical complexity. In patients with low clinical complexity, the risk-adjusted probability of severe hypoglycemia over the next 2 years was 1.02% with standard treatment and 1.30% with intense treatment.

But for those with disease of high complexity, the risk of hypoglycemia increased to 1.74% with standard treatment and 3.04% for intensive treatment.

Researchers concluded that more than 20% of patients with T2D received intensive treatment that may be unnecessary, which doubled their risk of hypoglycemia.

McCoy told TIME that while the risk of overtreatment was highest among seniors and those with other health problems, but that the findings were of relevance to all patients—and their doctors.

“In an effort to reduce undertreatment, and to make sure patients are tested and receive the appropriate treatment medications, we don’t have a counterbalance to ensure that patients are not overtreatment,” she told the magazine.

Reference

McCoy RG, Lipska KJ, Yao X, Ross JS, Montori VM, Shah ND. Intensive treatment and severe hypoglycemia among adults with type 2 diabetes. JAMA Intern Med. 2016. doi: 10.1001/jamainternmed.2016.2275.