Overtreatment of diabetes leads to thousands of hospitalizations each year

By Judith Garber | September 20, 2019

Activists have been calling attention to tragic, preventable deaths of young adults with Type 1 diabetes who are not able to afford their insulin. At the same time, overtreatment of older adults for Type 2 diabetes is common, harmful, and preventable.

A recent study by Grace K. Mahoney, MS of the Department of Biomedical Informatics, Harvard Medical School; Henry J. Henk, Vice President of Research at OptumLabs in Cambridge, MA; and Dr. Rozalina J. McCoy, endocrinologist at the Mayo Clinic, finds that inappropriately intensive treatment of type 2 diabetes leads to thousands of hospitalizations and emergency department visits for low blood sugar (clinically known as hypoglycemia) each year. While other studies have estimated the rates of overtreatment of diabetes in certain populations, this is the first study to estimate the number of hospitalizations and ED visits attributable to intensive treatment of diabetes in the full US population.

Type 2 diabetes is a chronic condition that affects nearly one in ten Americans. Type 2 diabetes is usually treated with diet, exercise, and sometimes medications to lower blood sugar levels. Keeping patients’ blood sugar levels under control is important for reducing diabetes symptoms and complications. However, lowering blood sugar too much can cause hypoglycemia, which can lead to fainting, seizures, and even coma.

Patients who are older and have multiple chronic conditions are at greater risk of adverse drug events like hypoglycemia. In fact, diabetes medications are among the most commonly implicated in ADEs leading to ED visits for Americans age 65 and older. Guidelines recommend that patients who are older or have multiple chronic conditions or advanced conditions (such as dementia or chronic kidney disease) be treated less intensively for type 2 diabetes, and that clinicians use a higher blood sugar target for these patients than for younger, healthier patients.

Nevertheless, Mahoney et al. found that between 2011-2014, about 21% of patients with below-average blood sugar levels were treated with medications to further lower their blood sugar, regardless of their age or other chronic conditions. As a result, there were more than 9,500 hospitalizations and ED visits for hypoglycemia over a two-year period due to intensive diabetes treatment. About 8,200 of these events could have been avoided if clinicians had identified the patient as someone at higher risk for hypoglycemia and treated them less intensively.

“Intensive treatment is a risk factor for hypoglycemic events. This is something that we as clinicians have control over and can prevent,” said study author Dr. Rozalina McCoy. “We need to recognize that there is no one-size-fits-all approach to lowering blood sugar.”

Patients can also help prevent future adverse events by telling their clinical team if they have an episode of hypoglycemia, and by asking about the harms and benefits of medications to lower blood sugar.

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.