Medicare claims data tell us that home health patients receiving daily nurse visits for the administration of insulin are more likely to receive emergency department and acute inpatient services for hypoglycemia than other Medicare beneficiaries with diabetes mellitus. A recent article by University of Michigan physicians may hold the key to understanding this apparent paradox. The authors take the position that “older diabetes patients are often overtreated” and provide readers with a link to the Veterans Administration (VA) site describing its Hypoglycemia Safety Initiative (HSI).

According to the VA:

“Roughly 50 percent of Veterans with diabetes being treated with medications have comorbidities including age greater than 75, renal dysfunction (serum creatinine>2.0 mg/dl), diabetic complications, cognitive impairment, and other serious medical or mental health conditions which increase their risk of serious hypoglycemia. About 50 percent of these Veterans have laboratory evidence (A1c less than 7 percent) of intensive management that increases risk of hypoglycemia without significant benefit.”

See more at the VA’s Quality, Safety, and Value HSI webpage. Similar circumstances may be at work in the Medicare home health population. What do you think?


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