We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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.
Text Size: A A A
Published online


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.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

3 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections