Blood glucose control is at the center of diabetes management, and for good reason. Decades of research show that good blood glucose control — which has varying definitions — is associated with a lower risk of long-term diabetes complications than persistently high blood glucose levels.
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But as innovations in technology and treatments have allowed doctors and people with diabetes to strive for blood glucose targets close to the “normal” or non-diabetic range, there is growing concern that the risk of hypoglycemia (low blood glucose) seen with intensive blood glucose control may negate some or all of the health benefits. A new study highlights the extent of this risk.
Published in the journal Mayo Clinic Proceedings, the study looked at adults with any type of diabetes with an HbA1c level (a measure of long-term blood glucose control) below 7.0% who participated in the U.S. National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014. Intensive control was defined as having an HbA1c level below 5.6% on any treatment, or an HbA1c level between 5.7% to 6.4% on two or more treatments. Overall, the researchers found that 21.6% of participants were intensively treated.
Study participants were also classified as having “clinically complex” diabetes if they were at least 75 or had end-stage renal disease, two or more daily living limitations, or three or more chronic health conditions. Among the 32.3% of participants who fit this definition, the researchers found just as great a chance of receiving intensive diabetes treatment as in less complex cases — which indicates that their doctors weren’t taking this complexity into account when making treatment recommendations.
Over a two-year period, the researchers calculated that there were 31,511 hospitalizations and 30,954 emergency room visits for hypoglycemia among all participants. Out of these, 4774 hospitalizations (15.2%) and 4804 emergency room visits (15.5%) could be blamed on intensive treatment, based on the difference in hospitalization rates between participants with and without this treatment.
The researchers noted that under current treatment recommendations, “intensive glucose-lowering therapy, particularly among vulnerable clinically complex adults, is strongly discouraged because it may lead to hypoglycemia.” By simply following these recommendations, doctors could reduce hospitalizations and emergency room visits for low blood glucose by about 15%.
Want to learn more about hypoglycemia? Read “Understanding Hypoglycemia” and “Exorcising the Specter of Overnight Hypoglycemia.”
A freelance health writer and editor based in Wisconsin, Phillips has a degree in government from Harvard University. He writes on a variety of topics, but is especially interested in the intersection of health and public policy.