Wellness Update - - News -


— Any­one who takes medicine to get their blood sugar or blood pres­sure down – or both – knows their doc­tor pre­scribed it to help them. But what if stop­ping, or at least cut­ting back on, such drugs could help even more? In some older peo­ple, that may be the safer route. But two new stud­ies pub­lished in JAMA In­ter­nal Medicine sug­gest doc­tors and pa­tients should work to­gether to backpedal such treat­ment more of­ten. In peo­ple in their 70s and older, very low blood pres­sures and sugar lev­els can ac­tu­ally raise the risk of dizzy spells, con­fu­sion, falls and even death. The con­se­quences can be dan­ger­ous. In re­cent years, ex­perts have started to sug­gest that doc­tors ease up on how ag­gres­sively they treat such pa­tients for high blood pres­sure or diabetes -- es­pe­cially if they have other con­di­tions that limit their life ex­pectancy. To see if such ef­forts to en­cour­age doc­tors to de-in­ten­sify treat­ment are work­ing, a team of re­searchers from the Univer­sity of Michi­gan Med­i­cal School and VA Ann Arbor Health­care Sys­tem stud­ied the is­sue from two sides: pa­tient records and a sur­vey of pri­mary care providers. They fo­cused on pa­tients over 70 with diabetes who had their blood sugar and pres­sure well un­der con­trol us­ing med­i­ca­tion. In all, only one in four of nearly 400,000 older pa­tients who could have been el­i­gi­ble to ease up on their mul­ti­ple blood pres­sure or blood sugar medicines ac­tu­ally had their dosage changed. Even those with the low­est read­ings, or the fewest years left to live, had only a slightly greater chance as other pa­tients of hav­ing their treat­ment de-in­ten­si­fied. Mean­while, only about half of the nearly 600 doc­tors, nurse prac­ti­tion­ers and physi­cian as­sis­tants sur­veyed said they would de-in­ten­sify the treat­ment of a hy­po­thet­i­cal 77-yearold man with diabetes and ul­tra-low sugar lev­els that put him at risk of a low-sugar cri­sis called hy­po­glycemia. Many providers said they wor­ried that de­creas­ing med­i­ca­tions for a pa­tient like this might lead to harm, and that de­creas­ing med­i­ca­tions might make their clin­i­cal “re­port cards” look worse. Some even wor­ried about their le­gal li­a­bil­ity.

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