January 28, 2014

Internal Medicine Claims Elderly Veterans Over Treated

Internal medicine doctors must be jealous because of all the veterans receiving excellent care from the Veterans Health Administration. So, they go and claim that the elderly veterans are being over treated because so many are on sulfonylureas or insulin. If ever I saw something to be less concerned about, it is something like this. I just know that veterans in general can take better care of themselves and are driven to do so by their determination and the military training they have experienced.

I know what the VA members of our support group are doing and all of them are under 6.5% when A1c is the comparison factor.

Patients at the Veterans Integrated Service Network facility demonstrated varying rates:
  • 8.5% to 14.3% for HbA1c less than 6%;
  • 24.7% to 32.7% for HbA1c less than 6.5%; and
  • 46.2% to 53.4% for HbA1c less than 7%.

However, over treatment rates were more significant, researchers wrote; with rates ranging from:
  • 6.1% to 23.0% for HbA1c less than 6%;
  • 20.4% to 45.9% for HbA1c less than 6.5%; and
  • 39.7% to 65.0% for HbA1c less than 7%.

What the report fails to tell us is how the over treated rates were determined, what the comorbid conditions were for those that were considered over treated, and what the age ranges were for those participants analyzed. This is the reason for the claim I make that internal medicine is jealous and can't stand that the veterans have better A1c's than their patients do.

If these veterans are in Veterans care facilities and they are being properly cared for, then the caregivers deserve credit for managing the patients very well. If this statement is correct - “The primary outcome was an HbA1c less than 7% in patients aged 75 years or older with a serum creatinine value greater than 2 mg/dL or a diagnosis of cognitive impairment or dementia,” then they are being cared for in a range to prevent the complications from becoming a serious factor.

Internal medicine prefers that the Veterans develop complications to have these serious conditions to treat. This is standard for many nursing homes where internal medicine doctors are in charge. In one nursing home, two diabetes patients each had amputations because they were not kept below an A1c of 12%. Another patient was due for an amputation and was legally blind because of retinopathy. His A1c was above 13%.

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