A Cleveland Clinic-led analysis uncovers ongoing challenges in tailoring diabetes treatment for seniors, showing many are not receiving appropriate adjustments based on blood-sugar levels and overall health status.
A Cleveland Clinic-led analysis suggests many older adults with type 2 diabetes are not having their treatment adjusted when blood-sugar readings fall outside recommended ranges, even though guidelines call for therapy to be tailored to overall health. The study, published in JAMA Internal Medicine, reviewed electronic health records from 2019 to 2023 and found that both overtreatment and undertreatment remained common among patients 65 and older.
Among nearly 90,000 patients, just 16.9% whose HbA1c was below target had their regimen deintensified, while 32.8% of those above target had treatment intensified. Phuc Le, the study’s lead author, said there were opportunities to better match treatment intensity to individual need, noting that some frailer patients continued to receive tighter control than may have been appropriate, while some healthier patients above goal did not get more aggressive therapy.
The American Diabetes Association recommends setting HbA1c goals according to health status. In the study, targets were considered less stringent for people in poor health, intermediate for those with multiple chronic conditions and tighter for healthier older adults. Overall, 7.9% of patients were classed as having good health, 61.6% intermediate health and 30.6% poor health. The average age was about 72, and half the cohort was male.
The researchers found that treatment intensification was uncommon even among older adults whose HbA1c exceeded goal, a pattern they described as a missed chance to reduce longer-term risks such as eye, kidney and cardiovascular disease. At the same time, intensification was also seen in some patients below goal, most often in those in poor health, which the authors said was troubling because of the higher risk of hypoglycaemia and other harms in frail or medically complex patients.
The findings fit with earlier research showing that many physicians still struggle to apply deintensification guidance in older adults. A national survey of doctors in general medicine, geriatrics and endocrinology found wide variation in when they would scale back hypoglycaemia-causing drugs, while other studies have shown that tools such as clinical decision support and shared decision-making can help more patients set individualised HbA1c goals. The broader message, the researchers said, is not that every result outside the target range requires a change, but that clinicians should make health status, life expectancy, treatment burden and patient preferences a more explicit part of diabetes care.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
