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Research Letter | Less Is More

Appropriate Prescribing for Patients With Diabetes at High Risk for Hypoglycemia National Survey of Veterans Affairs Health Care Professionals

Tanner J. Caverly, MD, MPH1,2,3; Angela Fagerlin, PhD1,2,3; Brian J Zikmund-Fisher, PhD3,4; Susan Kirsh, MD, MPH5,6; Jeffrey Todd Kullgren, MD, MS, MPH1,2,3; Katherine Prenovost, PhD1,2; Eve A. Kerr, MD, MPH1,2,3
[+] Author Affiliations
1Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
2Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor
3Department of Medicine, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
4Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
5Office of Specialty Care Transformation, Veterans Health Administration, Washington, DC
6Office of Specialty Care/Veterans Affairs Health Services Research and Development Quality Enhanced Research Initiative Evaluation Center, Louis Stokes, Cleveland, Ohio
JAMA Intern Med. 2015;175(12):1994-1996. doi:10.1001/jamainternmed.2015.5950.
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This survey study of primary care physicians assessed perceived barriers to deintensifying treatment in patients with diabetes at risk for hypoglycemia.

Evidence is accumulating that older individuals with diabetes mellitus have little to gain from the treatment burdens of stringent blood glucose control.1,2 In addition to concerns about increased mortality with tight control,1 some older patients with diabetes may also be at risk for hypoglycemia-related harms from medications prescribed to meet standard hemoglobin A1c (HbA1c) targets.3 This problem has motivated patient safety campaigns that cue health care professionals to limit medications for certain older patients (eg, those with an HbA1c level <7.5%, renal disease, or dementia) (to convert HbA1c to a proportion of total hemoglobin, multiply by 0.01).4 In this study, we examined beliefs of primary care health-care professionals (PCPs) to anticipate how PCPs might receive such recommendations.

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