Some older people with diabetes may use too much insulin

In a new study, researchers found patients with type 2 diabetes who were in poor health were more likely to continue taking insulin after age 75 than their counterparts in better health.

As people with type 2 diabetes age, the risks of insulin use can outweigh its benefits, creating the need for an increased provider and patient education.

Older adults who continue to use insulin are at greater risk of dangerously low blood sugar, or hypoglycemia.

The research was conducted by a team from Kaiser Permanente.

Insulin is a hormone that helps the body regulate sugar in the blood and is a key component of treatment for many patients with type 2 diabetes.

Scientists recommend reducing diabetes treatment intensity for older patients, particularly when they have multiple, life-limiting health conditions.

But this study shows that these sicker patients were less likely to stop taking insulin.

Older adults who continue to use insulin are at greater risk of dangerously low blood sugar, or hypoglycemia; this can happen when people take too large a dose of insulin.

In the study, the team followed 21,531 people age 75 and older in Northern California who had type 2 diabetes.

Nearly one-fifth of the patients used insulin at the beginning of the study, and among them, about one-third discontinued its use over the next 4 years.

The researchers found insulin use was highest among older adults in poor health (29% of them used insulin) with a serious end-stage disease or intermediate health (28% used insulin) with at least two other health conditions.

In contrast, just 11% of those in good health used insulin. The findings were similar even when researchers took into account how well patients were controlling their blood sugar.

The team says revisiting the need for potentially harmful medications such as insulin when the risks outweigh the benefits can help to reduce adverse events like hypoglycemia and improve the quality of care in older patients.

The team hopes to raise awareness about the need for physicians and patients to have conversations and reconsider medications that may lose benefit or add more risk as patients age.

The lead author of the study is Richard W. Grant, MD, MPH, a research scientist with the Kaiser Permanente Division of Research in Oakland.

The study is published in JAMA Internal Medicine.

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