In patients over 65, who have been living with type 2 diabetes for several years and to whom the disease has already caused some scares, intensive treatment with insulin or other oral drugs does not reduce its complications and can worsen its qualitylife.This is the main conclusion of a study that has just been made known and that launches an important message to specialists: customize therapy.
Although the work that has just been made known in the Journal of the American Medical Association is based on a simulation with a statistical model, as explainedOf cardiology (SEC), the main message comes to insist on something that has already underlined other studies: "In patients of a certain age, with many years of evolution and extensive affectation caused by diabetes, it was already known that the treatment can beeven harmful. "
According to the newspaper El Mundo, in these patients, intensive insulin treatment can cause very abrupt sugar declines that have been related to an increase in the risk of heart attack.Instead, Dr. Cordero clarifies, in young patients, who have not yet developed complications for diabetes, "it is shown that the strict control of blood sugar levels is beneficial for them."
In the work published by Sandeep Vijan and their colleagues in the veterans system at the University of Ann Arbor (in collaboration with that of Michigan and the British University College), it is recognized that the discomfort and side effects of insulin treatment can beeven superior to the small benefits that these drugs achieve in older patients.
As they themselves explain, the objective of treating diabetes and keeping glycosylated hemoglobin levels under control (a protein that allows you to measure diabetes control in the last month) is to prevent vascular complications (in kidneys, eyes or cardiac level).
However, taking into account that the benefits of treatment decrease with age (especially from 75 years), that some of these complications may take decades to appear and that their use can be associated with certain discomfort, weight gainetcIt is important that these two extremes get on the balance.
As Dr. Cordero clarifies, specialists do agree on the importance of treating diabetes "especially at the beginning", keeping glycosylated hemoglobin at bay, but perhaps in other types of patients, the benefits that are achieved with theTreatment against the cost it has for its quality of life.In fact, the authors of the study in JAMA insist that their conclusions are not valid for all types of patients with type 2, and stress that reducing the pharmacologically blood sugar levels does have great benefits for certain risk patients (ageyounger), which require a more aggressive treatment to control their disease.
For his part, Dr. Rafael Gabriel, scientific director of the Diabetes Foundation, recalls that the work is based on a statistical model, from a large database that yes, but it is not a clinical trial.Beyond the caution, it coincides with their Spanish colleague in which doctors are already very sensitized with the importance of individualizing therapy and placing the patient's quality of life in a salary of the balance."It is true that in patients over 75 years, a very strict control of glycemia levels can have unwanted effects," he explained to the newspaper El Mundo.
In addition, it emphasizes that diabetes is not the only pathology that usuallyHaving these patients, who are often also hypertensive and can have heart or renal problems."Diabetes already affects the quality of life of patients, but if they are more fragile elderly, the affectation in their quality of life is usually greater," he concludes.
