Managing diabetes meds more complicated in elderly patients

This issue covers topics including management of diabetes in the elderly, the public release of Medicare payments to physicians, and new approaches to antivirals as flu season begins.

As part of managing diabetes therapy in their practice, internists must come up with just the right combination of diet and medication to control blood glucose and prevent adverse events, including hyperglycemia. But emerging evidence has indicated that treatment aimed at optimal lowering of blood glucose levels in elderly patients can in fact lead to hypoglycemia, sometimes severe enough to cause hospitalization. In this group of patients, perhaps more than any other, individualized targets are key to avoiding such serious adverse events. Stacey Butterfield, in this issue's story, looks at recent guidance on this topic and talks to experts about factors that could affect treatment in elderly diabetics, including patient preference, living arrangements, and duration of disease.

In April, the Centers for Medicare & Medicaid Services (CMS) released a large amount of data on Medicare payments to physicians, hospitals, and other suppliers. Physicians and physician groups, including the College, expressed concern that the data lacked context and could provide an inaccurate picture of the payments received. However, as some experts pointed out, the data were useful for spotting geographic trends and for other types of big-picture analysis. Our story looks at the ramifications of the data release and how it relates to the overall movement toward more transparency in medicine.

As another fall begins, so does another flu season. While vaccination is still an important part of flu prevention, clinicians also need to be prepared to treat those who do come down with the disease by following the most up-to-date guidance. Turn to our story to learn more.

Palliative care can still often be thought of as something that occurs near the end of life, but there's a strong argument for beginning discussions earlier, when such care can do patients and families more good. In a Q&A, Ryan DuBosar talks to Amy P. Abernethy, MD, PhD, FACP, immediate past president of the American Academy of Hospice and Palliative Medicine, about ways to broach the subject of palliative care.

How do you prepare for flu season? Are you comfortable with early discussions of palliative care? Let us know your thoughts.


Jennifer Kearney-Strouse