Overtreatment and undertreatment of common medical conditions—such as diabetes mellitus, hypertension, or hypercholesterolemia—has become a major global health problem [1], [2], [3]. The past years have seen an—often unjustified—increased use of glucose‐, lipid‐, and blood pressure‐lowering medications that is straining public healthcare systems with unnecessary costs. At the same time, “clinical inertia”, namely a failure to initiate or intensify therapy, creates avoidable health risks for patients.
Overtreatment is particularly problematic for elderly patients with several medical conditions.
Of these, undertreatment is much more dangerous as it contributes to the increasing incidence of common, chronic diseases. “Clearly, patients with significant disease should be treated when evidence indicates a possible benefit”, commented Daniel Morgan, Associate Professor of Epidemiology and Public Health and Medicine at the University of Maryland. “If we undertreat populations with diabetes and hypertension, we are likely to see increased cardiac and vascular disease”.
Overtreatment is a public health problem
But overtreatment has serious consequences, too. Glucose‐lowering medications to treat diabetes have been blamed for up to 25% of emergency hospitalizations in the USA to treat hypoglycemia [3]. Diabetic treatments have also been implicated in cardiovascular events, cognitive impairment, fractures, and death [4]. Aggressive hypertension treatments often cause hypotension with potentially severe side effects, including acute renal failure, hyponatremia, hypokalemia, and syncope [1]. Statins to treat hypercholesterolemia also have numerous side effects: high blood glucose, which increases the risk for diabetes, abnormal liver enzyme levels, and muscle pain or—more rarely—muscle damage. “The outcomes of potential overtreatment for the individual and public health are enormous”, commented Elbert Huang, Director of the Center for Translational and Policy Research of Chronic Diseases and Associate Director of the Chicago Center for Diabetes Translation Research at the University of Chicago, IL, USA. “Patients are exposed to the unnecessary risks …
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