Only one in three older Americans have their diabetes under control as measured by guidelines set by the American Diabetes Association, new Johns Hopkins Bloomberg School of Public Health research suggests.
Some argue that ADA guidelines may be too stringent for some older adults. But even using less stringent measures, the researchers found, there are still many older Americans whose diabetes is not well managed, a condition that can lead to multiple long-term health problems ranging from kidney disease to blindness.
In a report published in the July issue of Diabetes Care, the researchers also found serious racial disparities, primarily in women, in how well diabetes is being managed, with black women much less likely to have acceptable blood sugar, blood pressure and cholesterol levels than white women.
The findings suggest that there is a lot of work to be done to care for people with diabetes over the age of 65, a population universally eligible for government-funded health care through Medicare. But the research also raises questions about the value of broad guidelines for glucose and blood pressure control in older Americans considering that medications to lower blood sugar and blood pressure come with potentially serious side effects that may outweigh the benefits of pushing for lower sugar and blood pressure levels.
“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,” says study leader Dr. Elizabeth Selvin, a professor of epidemiology at the Bloomberg School. “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 undertreated? These are questions for which we don’t have answers.”