Diabetes medication ‘doing more harm than good’

Diabetes treatments could be doing more harm than good; particularly for the over 75s suggests new research. For many people, the benefits of taking diabetes medications – insulin injections or metformin – are so small that they are outweighed by the minor harms and risks associated with treatment. Treatment benefits decline with age, and by age 75 the ills of most treatments are likely to outweigh potential benefits. “In many cases, insulin treatment may not do anything to add to the person’s quality life expectancy,” said John S. Yudkin, Emeritus Professor of Medicine at University College London. “If people feel that insulin therapy reduces their quality of life by anything more than around 3-4%, this will outweigh any potential benefits gained by treatment in almost anyone with type 2 diabetes over around 50 years old.” Yudkin was part of an international team of researchers who modelled the net gains or losses to quality of life associated with treatments to lower blood sugar based on a twenty-year study of type 2 diabetes treatments involving 5,102 people in the UK. They looked at the effectiveness of treatment on preventing associated diabetes complications – kidney, eye and heart disease – comparing the reduced risk of such complications with the increased risk of side effects and the burden of taking medication.

Ultimately, the aim of treatment is not to lower blood sugar for its own sake but to prevent debilitating or deadly complications,” said Yudkin. “If the risk of these complications is suitably low and the burden of treatment correspondingly high, treatment will do more harm than good.

The study – published in JAMA Internal Medicine – found that whether a person benefits from diabetes treatments depends less on their blood sugar level than their age and the hassles and side-effects of treatments. “Ultimately, the aim of treatment is not to lower blood sugar for its own sake but to prevent debilitating or deadly complications,” said Yudkin. “If the risk of these complications is suitably low and the burden of treatment correspondingly high, treatment will do more harm than good. The difference between the two can never be defined by a simple figure like blood sugar level.” The study applies to the majority of type 2 diabetes patients with A1c levels  – a measure of haemoglobin A1c in the blood, indicating an average blood sugar level over the last three months below 8.5%. The study also included researchers from the University of Michigan and Ann Arbor Veterans Affairs Hospital. Effect of Patients’ Risks and Preferences on Health Gains With Plasma Glucose Level Lowering in Type 2 Diabetes Mellitus