Updated 26 January 2017

Intensive type 2 diabetes treatment can be risky

Hypoglycaemia (low blood sugar) is a serious potential complication of diabetes type 2 treatment.

Intensive treatment of blood sugar levels in some people with type 2 diabetes may cause serious complications, new research suggests.

A serious potential complication

"In this study, we found that, particularly among older patients and patients with serious chronic conditions, intensive treatment nearly doubled the risk of severe hypoglycaemia requiring medical attention, including hospitalisation," said lead author Dr Rozalina McCoy. She is an endocrinologist at the Mayo Clinic in Rochester, Minnesota.

Hypoglycaemia (low blood sugar levels) is a serious potential complication of diabetes treatment. The researchers said it can worsen quality of life and has been linked with cardiovascular events, dementia and death.

Read: Depression raises low blood sugar risk in diabetics

The researchers reviewed information from more than 31,500 American adults.

All had stable and controlled type 2 diabetes. None was taking insulin. None had a prior history of severe hypoglycaemia. Both of these factors are known to increase the risk for future hypoglycaemia, the researchers explained.

A severe hypoglycaemic episode

Nearly 19 percent of older patients and those with serious chronic conditions (clinically complex patients) received intensive blood sugar management. More than 26 percent of non-complex patients received intensive treatment of blood sugar, the study authors reported.

Overall, older and clinically complex patients were nearly twice as likely to develop severe hypoglycaemia as non-complex patients. Intensive treatment increased that risk by an additional 77 percent over two years, the researchers said.

Read: Low blood sugar may raise dementia risk in diabetics

"This means that 3 out of 100 older or clinically complex patients with [type 2] diabetes who never had hypoglycaemia before, whose [blood sugar] is within recommended targets and who are not on insulin will experience a severe hypoglycaemic episode at some point over two years," McCoy said in a Mayo news release.

Individualised treatments

"This does not even capture the more mild episodes of low blood sugar that patients can treat at home, without having to go to the doctor, emergency department or hospital," she added.

"These findings are concerning for many reasons," McCoy said. "Overtreatment results in greater patient burden, higher risk of medication side effects, and more severe hypoglycaemia, which can lead to serious injury and even death. It adds more unnecessary costs for patients and the health care system."

McCoy stressed the need for providing individualised treatments for people with type 2 diabetes.

The study was published online in the journal JAMA Internal Medicine.

Read more:

Symptoms of diabetes

Causes of diabetes

Diagnosing diabetes


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Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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