In recent months, the American Geriatrics Society has added this recommendation to its list of five in the "Choosing Wisely" campaign: "Avoid using medications to achieve hemoglobin A1c <7.5% in most adults age 65 and older; moderate control is generally better."
Lee says many organizations that establish quality benchmarks might want to see more research that expands results of a 2008 study, the ACCORD Trial. But that's been tough to finance, and most of the studies were supported by the pharmaceutical companies that make insulin, he says.
"It's not surprising to me that a for-profit company that is making medications is going to focus on the positive aspects of their products. And we can't expect anything else. That would be like asking Ford to tell us the worst thing about their cars. No, they're going to advertise the best things about their cars. That's just natural activity for a for-profit company."
The data about adverse consequences of some products comes out long after the initial trial. "In this case, after these medications have been in use awhile is when we get a much fuller sense of what the potential harms are. That's a weakness in our current system, but it's pretty clear that benefits are being reported much more assiduously than the evidence of harm," Lee says.