Doubts have arisen about whether the current treatment strategies for diabetes patients over 75 are always the best. There is little substantiated knowledge about treating this group, and adverse effects resulting from current strategies cannot be ruled out. Interventions used to treat diabetes and manage other risk factors for cardiovascular disease in patients over 75 years of age could be less stringent. This is the conclusion drawn by researcher Hans van Hateren after a long-term study in the Diabetes Knowledge Centre in Zwolle. He will be awarded a PhD by the University of Groningen on Wednesday 13 February.
The number of people with diabetes is high and still rising. More than a quarter of them are over 75. Yet very little is known about the effects that glucose regulation or medication to lower blood pressure have on this group. The benefits for younger patients are undisputed. The over-75s, however, are often under-represented in large-scale scientific studies, which is why doubts are arising about the current treatment strategies for this growing group of patients. Van Hateren hopes that his research will add scientific weight to decisions on treatment options for patients over 75 years old.
His research shows that the implications of traditional risk factors for cardiovascular disease (blood pressure, cholesterol and glycaemic regulation) are different for this group than for younger patients. For example, older people with raised blood pressure have a longer life expectancy. This makes it difficult to gauge the extent to which their blood pressure, cholesterol and blood sugar levels should be reduced. Although evidence supporting the beneficial effects of medication for this group is scant, it is still the group most commonly treated for these conditions.
Van Hateren also concludes that a drop in blood pressure on standing up (orthostatic hypotension) is very common among older people with diabetes; this increases the risk of falling. A drop in blood pressure of this kind is considered to be a side-effect of the medication taken to lower the blood pressure. He recommends asking this group regularly whether they feel dizzy or light-headed, as this is simpler than trying to measure orthostatic hypotension.
Van Hateren comes to the conclusion that it is very important to define the aim of treatment in older patients. He wonders whether it would be better to keep the risk of cardiovascular disease to a minimum or aim for the best possible quality of life. The estimated life expectancy and vulnerability of elderly people should be important factors when weighing up the pros and cons. Van Hateren stresses the case for defining individual aims and target values.
Hans van Hateren (Hardenberg, 1983) studied Medicine at the University of Groningen. He conducted his PhD research in the Diabetes Knowledge Centre at the Isala Clinics in Zwolle, as part of the long-running ZODIAC study. His thesis is entitled: ‘Diabetes care in old age’. He works as a General Practitioner trainee at the UMCG and as a physician-researcher at the Diabetes Knowledge Centre in Zwolle.
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