Many people take medications for blood sugar and blood pressure concerns. These medications are very helpful to these people. Sometimes however, too much of these medications can cause significant problems. In our practice we see, and have seen, many patients with complaints that may be related to being over medicated. In this article we offer a review of three studies published in 2020.
“One in ten older adults with type 2 diabetes mellitus are overtreated while one in four require modification of their current antihyperglycemic and antihypertensive treatments. Physicians are eager to intensify medications.”
A February 22, 2020 study (1) expressed the concerns of over 111 medical researchers in Turkey that there is a problem. This is a summary of their research with explanatory notes:
“Targeting better glycated hemoglobin (HbA1c) and blood pressure goals may endanger older adults with type 2 diabetes mellitus. Overtreatment of type 2 diabetes mellitus and hypertension is a trending issue, although undertreatment is still common. (The researchers) investigated the rates and predictors of overtreatment and undertreatment of glycemia and blood pressure in older adults with type 2 diabetes mellitus and physicians’ attitudes to deintensify or intensify treatment.”
The study examined adults over the age of 65.
Overtreatment of glycemia was defined as HbA1c < 6.5% plus the use of more than 2 oral antihyperglycemics or insulin.
Overtreatment of blood pressure was defined as systolic blood pressure more than 120 or diastolic blood pressure more than 65 (120/65) plus the use of more than two drugs.
Undertreatment of glycemia was defined as HbA1c > 9%, and blood pressure undertreatment was defined as 150/90.
The rate of overtreatment in the glycemia group was 9.8% (124 patients in a group of 1264) and that in the blood pressure group was 7.3% (77 patients in a group of 1052).
“The results show that one in ten older adults with type 2 diabetes mellitus are overtreated while one in four require modification of their current antihyperglycemic and antihypertensive treatments. Physicians are eager to intensify medications while they largely ignore deintensification in diabetes management. These results warrant enforced measures to improve the care of older adults with type 2 diabetes mellitus.”
The “Paradox of glycemic management”
In the United States, a February 8, 2020 study (2) from the Mayo Clinic suggested: “Glycemic targets and glucose-lowering regimens should be individualized based on multiple factors, including the presence of comorbidities (other health concerns the patient may have). (The researchers then) examined contemporary patterns of glycemic control and use of medications known to cause hypoglycemia among adults with diabetes across age and multimorbidity.
Among 194,157 patients with type 2 diabetes included in the study
45.2% had only concordant comorbidities, (these disorders include: hypertension, hyperlipidemia, retinopathy, and heart failure). With 13% more patients having at least one of these comorbidities in an advanced state.
30.6% had concordant and discordant, (discordant comorbidities include arthritis and depression).
The researchers point out that while treating one condition, patients may be put at risk for increasing symptoms of their other conditions. They write: “Older patients and patients with higher comorbidity burden were more likely to be treated with insulin to achieve (good) HbA1c levels despite potential for hypoglycemia and uncertain long-term benefit.”
“Patients with type 2 diabetes mellitus often experience hypoglycemia and weight gain due to treatment side effects”
A third February 2020 study (3) in the British journal BMJ Open suggested that “patients with type 2 diabetes mellitus often experience hypoglycemia and weight gain due to treatment side effects. Sulfonylureas (antidiabetic drugs) and the combination of Sulfonylureas and metformin (are among) the most common monotherapy and combination therapies.”
This study aimed to assess the glycemic goal attainment rates, hypoglycemic episodes, weight gain and treatment compliance among patients with type 2 diabetes mellitus receiving Sulfonylureas or Sulfonylureas and metformin.
Out of the 659 patients (average age 65) diagnosed with type 2 diabetes mellitus and (average 10 years),
313 (47.5%) achieved the glycaemic goal.
Goal attainment was significantly lower among patients treated with Sulfonylureas and metformin than those treated with Sulfonylureas alone
A third of patients reported experiencing hypoglycaemia (30.7%) and weight gain (35.4%).
Weight gain in the Sulfonylureas and metformin group was lower than those receiving Sulfonylureas alone (33.1% vs 44.6%), but there was no difference in hypoglycemic events.
Major events in the previous 12 months were experienced by 68 patients, most commonly congestive heart failure and ischaemic heart disease.
Approximately half of the patients (52.2%) reported not always taking their medication as prescribed.
Unfortunately, they typically come with a boatload of side effects, which include upping your risk of suffering an amputation, genital infections, kidney disease or a frightening episode of hypoglycemia. At the Magaziner Center we treat diabetes holistically, as well as addressing any additional conditions that can accompany it, such as cardiovascular disease and diabetic neuropathy.
At the Magaziner Center, we treat type 2 diabetes holistically. As pointed out in the research above, attention is given to the existing co-problems. We use extensive and unique testing to root out all of the contributing factors and treat them at the source. Many of our patients are placed on a gluten-free, plant-based diet, along with an appropriate exercise and stress reduction programs. In many cases, the first step is assisting patients with a healthy weight loss program, through either dietary modifications or including medically-based diets that stimulate metabolism, suppress appetite and mobilize fat. We also use nutriceuticals and herbal and nutritional supplements to assist in metabolism and help combat glucose intolerance.
If you would like to explore more information, please contact our office so we can start a conversation with you.
1 Sonmez A, Tasci I, Demirci I, Haymana C, Barcin C, Aydin H, Cetinkalp S, Ozturk FY, Gul K, Sabuncu T, Satman I, Bayram F. A Cross-Sectional Study of Overtreatment and Deintensification of Antidiabetic and Antihypertensive Medications in Diabetes Mellitus: The TEMD Overtreatment Study. Diabetes Ther. 2020 Feb 22. doi: 10.1007/s13300-020-00779-0.
2 McCoy RG, Lipska KJ, Van Houten HK, Shah ND. Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes. BMJ Open Diabetes Res Care. 2020;8(1):e001007. doi:10.1136/bmjdrc-2019-001007
3 Satirapoj B, Pratipanawatr T, Ongphiphadhanakul B, Suwanwalaikorn S, Benjasuratwong Y, Nitiyanant W. Real-world Evaluation of glycemic control and hypoglycemic Events among type 2 Diabetes mellitus study (REEDS): a multicentre, cross-sectional study in Thailand. BMJ Open. 2020;10(2):e031612. Published 2020 Feb 12. doi:10.1136/bmjopen-2019-031612