Some researchers believe that the ADA guidelines might be too stringent for older adults, which in turn skew these results. However, even when utilizing less stringent rules, researchers found there are still many older Americans who do not manage their diabetes well, which can lead to several long-term health problems such as kidney disease and blindness.
A recently published report in the Diabetes Care journal explains that researchers also noticed crucial racial disparities, especially in women, in how diabetes is being managed: African-American women are much less likely to maintain acceptable blood sugar, cholesterol levels and blood pressure in comparison to white women.
This suggests there is still much to be done concerning care of those over 65 with diabetes. In addition, medications to lower blood sugar and blood pressure might have severe side effects that outweigh the benefits — a factor that needs to be especially considered with senior citizens.
“This research gives us a good picture of diabetes control in older adults and gets us thinking about what it means that older Americans are not meeting clinical targets and how we should address this from a public health perspective. There is tremendous debate about appropriate clinical targets for diabetes in older adults, particularly for glucose control. Are some older adults being over-treated? Are some being under-treated? These are questions for which we don’t have answers,” noted Elizabeth Selvin, study leader.
For this project, data from the Atherosclerosis Risk in Communities Study (ARIC) was used, which followed 15,792 middle-aged adults from North Carolina, Maryland, Minnesota and Mississippi. Researchers assessed hemoglobin A1C, LDL cholesterol and blood pressure, discovering that when they were less stringent in these levels according to ADA standards, results were better but still off-target.
The scientists highlighted that those with poor diabetes management behaviors might be more likely to develop other diseases since diabetes can be associated with kidney disease, nerve damage and blindness, and they should be kept under surveillance.
“There is a question in this field of how much good we are doing as opposed to harm when we try to tightly control diabetes in older people, because the treatments are not benign in older adults,” Parrinello added. “If the primary benefit of glucose control, for example, is to prevent kidney, eye and nerve damage — complications that take 10 to 20 years to develop — maybe it doesn’t make sense to focus on glucose control in certain patients where diabetes may be the least of their concern.”
Additional research is required to assess the best targets to assess diabetes in older populations and to confirm the racial disparities.