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Weigh up ‘burden’ of diabetes treatments against benefits, says study

Treatment can do more harm than good if the burden is greater than the risk of diabetic complications, the study advises

Clinicians should make decisions about treat patients with type 2 diabetes based on the realistic benefits rather than their blood sugar level, a new study has suggested

Clinicians should make decisions about treating patients with type 2 diabetes based on the realistic benefits rather than their blood sugar level, a study has suggested.

Using blood sugar levels alone to determine the treatment of type 2 diabetes patients was a "flawed strategy" and clinicians should individualise treatments by taking account of a patient's age and their attitude towards treatment, researchers at University College London (UCL) said in a study published in JAMA Internal Medicine on Monday (June 30).

Health professionals had access to an "expanding arsenal" of diabetes treatments but should weigh up whether the benefits of reducing blood sugar levels were outweighed by the "burden" of taking medication or insulin injections, said the study's authors, which also included researchers from the University of Michigan and the Ann Arbor Veterans Affairs Hospital, Michigan.

The benefits of treatment, such as reducing kidney and eye disease, were "modest" in patients over 50 whose diabetes was well-controlled. For these patients, the side effects and associated risks of treatment, such as weight gain, hypoglycaemia and gastrointestinal effects, could outweigh the benefits, the authors said in the study, which looked at 5,102 diabetes patients in the UK alongside published medical evidence.

A typical person with type 2 diabetes who started treatment at 45 and reduced their glycosylated haemoglobin (HbA1c) level by 1 per cent, could gain up to 10 months of healthy life, the authors said. However, a patient aged 75 was likely to gain only three weeks of healthy life and it should be up to the patient to decide whether that was worth years of treatment, the authors stressed.

John Yudkin, emeritus professor of medicine at UCL and co-author of the study, said the aim of treating patients with type 2 diabetes was to prevent debilitating complications and not to lower blood sugar levels "for its own sake".

"If the risk of these complications is suitably low and the burden of treatment correspondingly high, treatment will do more harm than good. The balance between the two can never be defined by a simple figure like blood sugar level," he added.

Simon O'Neill, director of health intelligence at charity Diabetes UK, said the study highlighted the need for health professionals to discuss treatments with a patient and weigh up the benefits and side effects rather than adopting a "blanket approach".

Does the study's suggestions resonate with your experience of patients with diabetes?

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