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Finding adverse
Among 1,288 adults aged 65+ with diabetes, 61.5% had HbA1c less than 7% and 54.9% of these were treated with insulin or sulfonylureas; among patients with very complex/poor health, 56.4% had HbA1c <7% and 37.9% had HbA1c <6.5%, representing overtreatment where tight control is unlikely to benefit and may cause hypoglycemia.
Effect size61.5% had HbA1c <7%; among complex/poor health patients, 56.4% had HbA1c <7% and 37.9% had HbA1c <6.5%
ComparatorADA/AGS guideline-recommended less aggressive glycemic targets for older patients with limited life expectancy
Effect summaryadverse; 61.5% had HbA1c <7%; among complex/poor health patients, 56.4% had HbA1c <7% and 37.9% had HbA1c <6.5%
Adverse eventshypoglycemia
Effect modifiers[{"modifier": "Health complexity status", "interaction_p": "", "direction": "null", "stratum_details": "Complex/intermediate: 63.0% had HbA1c <7%; very complex/poor: 56.4% had HbA1c <7%", "plain_language": "Even the sickest elderly patients with the shortest life expectancy were almost as likely to have their blood sugar pushed too low as healthier older adults", "annotation_notes": "The clinical significance increases with health complexity because the harm-to-benefit ratio worsens, even though the prevalence is slightly lower"}]

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Source

PMC5564394
Update on Medical Overuse
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