Guidelines from the Institute of Safe Medication Practices have pointed out that insulin is associated with more medication errors than any other type or class of drugs. With more than 11,400 insulin-using veterans hospitalized in a recent two-year period at the VA, that is an especially critical issue for the healthcare system. Intense focus on avoiding problems with insulin, as well as new products, have improved the situation, both with subcutaneous administration – such as insulin pens – and with intravenous insulin in the critical care setting.
At one point, intensive glycemic control was seen as a magic bullet to keep Type 2 diabetes patients from developing cardiovascular disease. That approach faded, however, when VA research cautioned that any benefits of intensive therapy must be weighed against adverse effects such as hypoglycemia and weight gain. Now the focus has shifted to better medication selection, with guidelines suggesting that, for Type 2 diabetes patients who have cardiovascular disease or are at high risk for it, therapy including an SGLT-2 inhibitor or GLP-1 RA should be considered as optimal treatment.
While, in general, the U.S. military will not accept recruits diagnosed with diabetes, that is especially the case with patients who use insulin, which is seen as an automatic disqualification. The situation is different, however, in military personnel already serving. While most of those retained after diagnosis have well-controlled blood sugar, about a third have hemoglobin A1c measures greater than 7%. That’s why the ability to closely monitor those servicemembers with tools such as continuous glucose monitoring is increasingly important.
BOSTON — About 10% of older veterans discharged from VAMCS had their diabetes medication intensified, even though half of them were unlikely to benefit because either they already had reached their blood glucose goals or had limited life expectancy.