TOO MUCH,TOO LATE:
ANN ARBOR, Mich.
— 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.