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By Lisa Rapaport
A new study suggests that doctors' advice to start or stop medications for diabetes does not resonate in older patients.
To determine how much medication patients should take and how low their blood glucose levels should be, doctors rely on medical recommendations to balance the benefits against the side effects and harms of treatment, said Dr. Nancy Schoenborn, author principal of the study and gerontologist. researcher at the Johns Hopkins University School of Medicine in Baltimore.
But older patients often believe the opposite of what the guidelines recommend, "either because the information is not intuitive and better communication and education is needed, either because what the guidelines consider important is not important for patients and we need to better understand which patients value our decisions, "Schoenborn said via e-mail.
For example, the guidelines indicate that a person with many health problems unrelated to diabetes may be at a higher risk of aggressive diabetes treatment and should therefore probably take lower doses of diabetes medications than of a person presenting no other health problem, Schoenborn said.
"The majority of people interviewed as part of the study thought it was the opposite," Schoenborn said. "We can not say if that's because they need to better understand the guidelines or if they just disagree, but that can certainly create confusion and disagreements for them. doctors and patients when they are trying to make a decision together, especially if the doctor did not know that the patient might not be on the same page. "
Recommendations for the management of diabetes in the elderly include measures such as less aggressive control of blood glucose in people with limited life expectancy, as well as factors such as diabetes complications, side effects of drugs, their other health problems and how. easily, they can afford their medication.
For the drugs at the stop and at the beginning of the treatment, the patients thought that the undesirable effects were the most important factor to take into account.
Contrary to the recommendations, patients also thought that people who had lived with diabetes longer or who had more complications or other health problems should be treated more aggressively, such as more drugs or higher doses.
As reported in JAMA Internal Medicine, researchers surveyed 818 diabetics aged 74 years on average to determine what factors they considered important in determining whether to stop or start antidiabetic drugs.
While 46% to 63% of patients agreed with the guidelines recommendations for when to start a new drug, only 8% to 38% thought that guideline factors were important in determining when to stop taking a drug.
The study was not designed to prove that the understanding of treatment guidelines by patients had an impact on health outcomes.
Nevertheless, the results suggest that some patients may be taking medications they no longer need or taking medications that may help them, the study concludes.
"Guidelines for individualized glucose goals are not intuitive for patients and better communication is needed, as well as more research to better understand patients' perspectives and preferences," said Schoenborn.
SOURCE: http://bit.ly/2Ap15do JAMA Internal Medicine, online September 16, 2019.
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