Understanding Your Diabetes Treatment Plan

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What you don’t know won’t hurt you, as the saying goes. But that’s far from true when it comes to managing type 2 diabetes. Understanding the reasoning behind your individual treatment puts you on the right track to controlling your diabetes and helps better prepare you to make educated decisions about your self-care.

Yet, based on a recent study that involved a nationwide survey of 818 people ages 65 and older with type 2 diabetes, many patients don’t fully understand the reasons for certain aspects of their treatment, potentially setting them up to be over- or under-treated. For the study published in September 2019 in JAMA Internal Medicine, researchers at Johns Hopkins asked patients to rate seven factors that would most affect their decision to increase or reduce diabetes medication.

Nearly half of the respondents’ answers were the opposite of what American Diabetes Association (ADA) guidelines recommend. Older adults tended to downplay significant factors that doctors consider when judging how aggressive treatment should be. Most respondents consistently opted for more aggressive treatment when the guidelines often called for less. While this might sound counterintuitive, the general trend in diabetes care is to recommend less aggressive treatment as people get older.

A tailored approach
Successful diabetes control calls for an individualized treatment plan with a tailored blood sugar (glucose) goal, typically as measured by the hemoglobin A1c test. The hemoglobin A1c is a blood test that measures the amount of glucose attached to hemoglobin—the oxygen-carrying protein in red blood cells that gives blood its color. As blood sugar levels rise, so does the amount of glucose attached to hemoglobin.

Your diabetes care should be adjusted as you age, which includes modifying your medications. The study identified the following seven factors as key to deciding whether treatment should be more aggressive or less aggressive:

1. Diabetes duration
2. Established diabetes complications
3. Other health conditions
4. Life expectancy
5. Risk of side effects from diabetes treatment
6.Treatment costs