Know when to reduce ongoing treatment
Q: I’m 68 and have been on metformin for almost 25 years. I also have been taking a sulfonylurea for eight years. Recently I have had two scary incidents of low blood sugar. I used to be able to keep everything on a pretty even keel. What’s changed? — Janie P., Lansing, Michigan
A: Time may be the great healer, but it can also be the great troublemaker — at least when it comes to staying on a treatment regimen for years. There’s been such a focus on getting folks on life-saving treatments and increasing their compliance that the whole issue of reducing treatment as a patient gets older has been largely overlooked.
Researchers at Michigan Medicine, the University of Michigan’s academic medical center, and the VA Ann Arbor Healthcare System decided to do the first-ever extensive examination of the effect of sustained routine adult primary care for a whole slew of conditions.
One of their 37 high-priority deintensification recommendations concerns Type 2 diabetes treatments. They found that as people with Type 2 diabetes get older, they don’t need to take multiple medications.
So, Janie, ask your doc to look at the study in JAMA and consider if you really need to maintain treatment. But never stop or reduce your current medical treatment without permission from your doctor.
Q: I’m not overweight, but my doctor keeps telling me I have to pay more attention to what I eat because I’m going to end up with plaque buildup in my arteries. Seems to me I’ve eliminated the biggest risk factor — obesity — so why should I worry? — Carl D., Indianapolis
A: It’s true that most folks who are obese — or even overweight — have elevated lousy LDL cholesterol and plaque buildup in their cardiovascular system.
But you don’t have to be obese to have heart disease.
A new study published in PLOS Medicine proves that. Over 21 years of follow-up, researchers found that folks with a normal body weight index who did not eat a Mediterranean-style diet were 75 percent more likely to die from cardiovascular disease than normal-weight folks who ate Mediterranean. The Med diet was defined as getting 35 percent of calories from fat — 22 percent from monounsaturated fats like olive oil — and less than 50 percent of calories from carbs.
So avoid red meats, enjoy fish and embrace healthy oils like olive oil. Your heart and brain will thank you with a longer, healthier life.