Doctors slow to switch diabetes treatment when oral meds don’t work
MAY 16, 2018- Reuters Health News –
When type 2 diabetes isn’t well controlled with oral medications, doctors are often slow to switch patients to more intensive treatment, a US study suggests.
Researchers found that only about one-third of patients with poorly controlled blood sugar on oral drugs were switched to higher doses, different drugs, or insulin within 6 months.
At the start of the study, all of the patients had been taking two oral diabetes drugs for at least 6 months, but they still had hemoglobin A1c levels of at least 7.
Under US guidelines for managing diabetes, all such patients should be switched to more intense treatment, researchers noted April 20 online in Diabetes Care.
But 6 months after the start of the study, doctors had only prescribed more intense therapy for 37% of these patients.
“Generally speaking, if a patient’s A1c is above target, it will either remain there or get worse,” said lead study author Dr. Kevin Pantalone of the Cleveland Clinic in Ohio. “It does not usually get better.”
Too often, doctors and patients will find reasons not to intensify treatment, making these complications more likely, Pantalone said by email.
“Whether it be the patient saying for the fifth time ‘I will start watching my diet and start exercising,’ or a physician saying ‘the A1c is close to goal and I don’t really want to add yet another medication and copay, we will wait and see what happens in another 3 months,’ the end result is lack of intensification and A1c goal attainment,” Pantalone said.
In the current study, researchers examined electronic health records for 7,389 patients with poorly controlled diabetes who were treated at the Cleveland Clinic between 2005 and 2016.
People with the most poorly controlled blood sugar were more likely to get more intense treatment, the study found.
Among patients with A1c readings from 7 to 7.9, just 28% were switched to more intense treatment during the study.
However, about 47% of patients with A1c readings from 8 to 8.9 were switched, as were almost 60% of patients with A1c readings of 9 or higher.
The study wasn’t designed to prove whether or how treatment intensification might directly improve blood sugar control. Researchers also lacked data to explain why doctors or patients might have decided against a change in therapy. And the study didn’t show whether failure to switch treatment regimens resulted in diabetes complications.
Still, such complications can become more likely the longer patients go with poorly controlled blood sugar, said Dr. Vanessa Arguello of the David Geffen School of Medicine at the University of California, Los Angeles.
“When appropriate, patients need to be involved in escalating their diabetes care to prevent diabetic complications and stay healthy,” Arguello, who wasn’t involved in the study, said by email.
“Patients should empower themselves by checking their blood sugars daily, knowing what their target blood sugar levels should be, and having regular appointments with their…