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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
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
24.7% to 32.7% for HbA1c less than
46.2% to 53.4% for HbA1c less than
However, over treatment rates were more
significant, researchers wrote; with rates ranging from:
6.1% to 23.0% for HbA1c less than
20.4% to 45.9% for HbA1c less than
39.7% to 65.0% for HbA1c less than
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%.