Tip Sheet: Diabetes Tests and Treatments

When you need them—and when you don’t

If you have diabetes, taking good care of your health is important. But some tests and treatments aren’t right for everyone. Some may  not be helpful. Others may be harmful. Use this advice to talk to your doctor about the best way to manage your health.

If you’re over age 65 and have type 2 diabetes, medicine may not be the best option for managing your diabetes

The hemoglobin A1c (HbA1c) test shows your average blood glucose (blood sugar) level for the past 3 months. For many years, doctors thought people with diabetes should do whatever it took to push their HbA1c level below 7.0 percent. For people with type 2
diabetes, that can mean taking medicines that lower blood sugar. But recent studies in older people with heart disease show that it’s better to keep HbA1c levels between 7.0 and 8.0.

Some medicines can lower blood sugar levels too much. These medicines affect older adults more than other people. For older adults, having low blood sugar can be harmful—or even deadly. They are more likely to need to go to the hospital for low blood sugar.

For most older adults, there is no proof that keeping HbA1c levels below 7.0 is better for your health over the long term.

The American Geriatrics Society says to keep your blood sugar level in a healthy range by staying at a healthy weight, eating right, and staying active. These steps are often enough to manage type 2 diabetes. If your HbA1c level falls below 7.0 without medicine, that’s OK. But you may not need to take medicine to push your HbA1c level below 7.0.

If your HbA1c level rises to the high 7s or above 8.0, talk to your doctor. Ask if you should take medicine to lower your blood sugar. The choice of medicine is important. Some medicines are more likely to cause lower blood sugar than others. Ask your doctor about the symptoms of low blood sugar, such as feeling shaky and confused. Also ask how to treat low blood sugar if you get it. It can be serious.

If you have type 2 diabetes and don’t use insulin, home blood glucose testing usually isn’t needed

Some doctors tell everyone with diabetes to check their blood sugar level at home—sometimes several times a day. People with type 1 diabetes need to do this. So do people with type 2 diabetes who take insulin.

However, if you have type 2 diabetes and don’t take insulin, you likely don’t need to do home testing. Studies show that checking your blood sugar at home will likely not improve your health.

Home testing requires you to prick your finger. Many people find this painful. Plus, the supplies used for home testing are costly—more than $700 a year. Home testing is a waste of money and effort when there’s no benefit.

If you have type 2 diabetes and don’t take insulin, get an HbA1c test at least twice a year—or as often as your doctor says to. This test shows your average blood sugar level for the past 3 months.

No matter what type of diabetes you have—or what type of medicine you take—you should lead a healthy lifestyle. This means staying at a healthy weight, eating right, and staying active. That’s what the Society of General Internal Medicine recommends.

Last Updated October 2017

About Choosing Wisely®

This tip sheet is provided by The Choosing Wisely® campaign, an initiative of the ABIM Foundation. The mission of Choosing Wisely is to promote conversations between clinicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

The recommendations in this tip sheet were developed in cooperation with the American Geriatrics Society and Society of General Internal Medicine.

This report is for you to use when talking with your health care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

To learn more, visit: www.choosingwisely.org/patient-resources.

©2017 Consumer Reports®