By Lisa Rapaport

Doctors’ advice for starting or stopping diabetes medicines often doesn’t resonate with older patients, a new study suggests.

When deciding how much medicine patients should take and how low their blood sugar needs to be, doctors use medical guidelines to balance the benefits against the side effects and burdens of the treatment, said Dr. Nancy Schoenborn, lead author of the study and a gerontology researcher at 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 are needed, or because what the guidelines think are important are not important to patients and we need to better understand what patients do value when making decisions,” Schoenborn said by email.

For example, guidelines say someone with many health conditions unrelated to diabetes can have more risks from aggressive diabetes treatment and therefore should probably be on lower doses of diabetes medicines than someone with no other health conditions, Schoenborn said.

“The majority of survey respondents in the study believed the opposite to be true,” Schoenborn said. “We cannot say if this is because they need to understand the guidelines better or they just disagree with the guidelines, but certainly this can lead to confusion and disagreements for doctors and patients when they are trying to make a decision together, especially if the doctor was not aware that the patient may not be on the same page.”

Guidelines for managing diabetes in older adults include things like less aggressive blood sugar control for people with limited life expectancy as well as considering factors like what diabetes complications they have, what side effects they’re having from medications, their other health problems, and how easily they can afford their medicines.

For both stopping and starting medicines, patients thought side effects were the most important factor to consider.

Contrary to guidelines, patients also thought people who had lived with diabetes longer or who had more complications or other health problems should receive more aggressive treatment, like more medicines or higher dosages.

As reported in JAMA Internal Medicine, researchers surveyed 818 diabetics who were 74 years old on average to see which factors they considered important when weighing whether to stop or start diabetes medicines.

While 46% to 63% of patients agreed with guidelines’ recommendations about when to start new medicine, only 8% to 38% thought factors in the guidelines were important for determining when to stop taking a drug.

The study wasn’t designed to prove whether patients’ understanding of treatment guidelines impacts health outcomes.

Even so, the results suggest some patients may be taking medicines they no longer need or take drugs that might help, the study team concludes.

“The guidelines about individualized blood sugar targets are not intuitive to patients and better communication is needed, as is more research to better understand patients perspectives and preferences,” Schoenborn said.

SOURCE: JAMA Internal Medicine, online September 16, 2019.