I recently came across an article in a physician’s journal titled, “Diabetes Medications: Should You De-prescribe Them in the Elderly?”
My short answer?
Yes — absolutely.
First of all, recent clinical trials show setting strict blood sugar targets in the elderly causes many serious problems. And achieving these strict targets offers very few benefits, as I’ll explain in a moment.
Plus, to achieve stringent blood sugar control, doctors often resort to prescribing multiple drugs to their elderly patients. But dangerous side effects add up and compound exponentially when you take several medications. There’s even a term for this increasingly common practice — polypharmacy. And it’s especially dangerous — and extremely common — in older people.
The problem with polypharmacy has gotten so bad, physicians, scientists, and pharmacists formed a “de-prescribing project.”
Of course, this project isn’t based in the U.S. It comes from the Bruyère Research Institute in Ottawa, Canada.
And the researchers aim to inform healthcare professionals about stopping, switching, or simply lowering the dosage of diabetes medications patients take, especially older people.
How sensible! If only modern medicine in this country would catch on…
Indeed, in older people, these drugs cause dangerous problems with low blood sugar — contributing to fainting, falls, fractures, and other hazards. In particular, the drugs offer questionable benefits in people who also struggle with dementia, frailty, and a shorter life expectancy — the low blood sugar caused by these drugs is even more dangerous for them.
Plus, newer clinical trials show older, more stringent blood sugar guidelines don’t improve mortality from heart disease. Nor do they improve overall mortality — which should be the bottom line for all treatments.
Evidence shows these older guidelines actually increase the risk of episodes of low blood sugar, especially in older people. And an episode of low blood sugar can be fatal.
Furthermore, research links low blood sugar with cognitive impairments, cardiovascular events, fractures, reduced quality of life, and higher mortality risk.
Low blood sugar is also a leading cause of emergency department visits to the hospital in older adults in the U.S. Plus, if you’re hospitalized for low blood sugar, you have a very poor prognosis. (Whether due to the episode of blood sugar, or just being stuck in the hospital.)
(By comparison, high blood sugar is a long-term risk factor for chronic diseases of heart, eyes, kidneys, and peripheral nerves. But there’s little immediate risk to an episode of high blood sugar in Type II diabetes.)
Escaping the blood sugar merry-go-round
As a result, approximately five years ago, some agencies began to favor less stringent targets for people older than 65 years. And many national and international treatment guidelines now recommend aiming to reduce Hemoglobin A1C, the long-term measure of blood sugar, to less than 7.5 percent in healthy older adults and to less than 8.5 percent in the frail elderly.
Unfortunately, there’s a major disconnect between current science and what actually happens in medical practices across the country.
In fact, many older patients in the U.S. and Canada with Type II diabetes are still being treated too aggressively to reduce Hemoglobin A1C to less than 7.0 percent.
The Bruyère Research Institute is likely paying more attention to the science — as well as the sensible guidelines in Europe and the U.K. — where they established target goals for treatment at 7.5 percent.
“In the U.S. and Canada, the concept of treating to specific number targets has been very entrenched in the medical communities, so it is a difficult thing to change,” said lead author Barbara Farell, Ph.D.
She also added, “The diabetes guidelines all talk about how to start these drugs, and some discuss how to adjust doses for kidney function, or for age, but they don’t specifically address how to reduce a dose or how often to monitor while you are reducing it.”
It’s like the old merry-go-around where doctors know how to get patients on the drugs, but they don’t how to ever get them off. And it sounds like we really need some “deprogramming” of practicing physicians brainwashed by big pharma.
Of course, the overuse and proliferation of expensive, patented, new drugs for Type II diabetes is particularly regrettable, considering the superior results of metformin.
Metformin is the old standby Type II diabetes medication that actually derived from an ancient European folk remedy called French lilac — or goat’s rue in the U.S. (The USDA classifies it as a “noxious weed.”)
In addition, modern science shows that many natural supplements help reduce blood sugar and manage Type II diabetes. You can find more natural approaches for preventing and reversing Type II diabetes in my brand new online learning protocol, the Integrative Protocol for Defeating Diabetes.
In the meantime, talk to your doctor about switching to metformin, or at least lowering your dose if they insist you take another drug. And make sure they monitor your A1C levels carefully. If you’re being treated to manage blood sugar, your primary care physician will typically want to see you every four months or so to monitor your level of Hemoglobin A1C.
Always on the side of science,
Marc S. Micozzi, M.D., Ph.D.
“Diabetes Medications: Should you De-prescribe them in the elderly,” Medscape (www.medscape.com) 12/272017