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Quality, Safety & Value


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Available Literature

Guidelines and Performance Measurement

  1. American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus; Moreno G, Mangione CM, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society guidelines for improving the care of older adults with diabetes mellitus: 2013 update. J Am Geriatr Soc 2013;61:2020–2026
  2. Conlin PR, Colburn J, Aron D, Pries RM, Tschanz MP, Pogach L. Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: Management of Type 2 Diabetes Mellitus. Ann Intern Med 2017;167:655-663
  3. Qaseem A, Wilt TJ, Kansagara D, et al. Hemoglobin A1C targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians. Ann Intern Med 2018;168:569-576.
  4. Aron DC. No “black swan”: unintended but not unanticipated consequences of diabetes performance measurement. Jt Comm J Qual Patient Saf 2013;39:106–108
  5. O'Connor PJ, Bodkin NL, Fradkin J, et al. Diabetes performance measures: current status and future directions. Diabetes Care 2011;34:1651-1659
  6. Pogach LM, Tiwari A, Maney M, Rajan M, Miller DR, Aron D. Should mitigating comorbidities be considered in assessing healthcare plan performance in achieving optimal glycemic control? Am J Manag Care 2017;13:133-140
  7. Woodard LD, Landrum CR, Urech TH, et al. Treating chronically ill people with diabetes mellitus with limited life expectancy: implications for performance measurement. J Am Geriatr Soc 2012;60:193-201

Intensive Treatment / Overtreatment

  1. ACCORD Study Group. Nine-year effects of 3.7 years of intensive glycemic control on cardiovascular outcomes. Diabetes Care 2016;39:701–708
  2. Aron DC, Lowery J, Tseng CL, Conlin P, Kahwati L. De-implementation of inappropriately tight control (of hypoglycemia) for health: protocol with an example of a research grant application. Implement Sci 2014;9:58
  3. Caverly TJ, Fagerlin A, Zikmund- Fisher BJ, et al. Appropriate prescribing for patients with diabetes at high risk for hypoglycemia: national survey of Veterans Affairs health care professionals. JAMA Intern Med 2015;175:1994–1996
  4. Hamada S, Gulliford MC. Antidiabetic and cardiovascular drug utilisation in patients diagnosed with type 2 diabetes mellitus over the age of 80 years: a population-based cohort study. Age and Ageing 2015;44:566-573
  5. Hamada S, Gulliford MC. Mortality in individuals aged 80 and older with type 2 diabetes mellitus in relation to glycosylated hemoglobin, blood pressure, and total cholesterol. J Am Geriatr Soc 2016;64:1425-1431
  6. Hayward RA, Reaven PD, Wiitala WL, et al.; VADT Investigators. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2015;372:2197–2206
  7. Huang ES, Brown SE, Ewigman BG, Foley EC, Meltzer DO. Patient perceptions of quality of life with diabetes-related complications and treatments. Diabetes Care 2007;30:2478–2483
  8. McCoy RG, Lipska KJ, Yao X, et al. Intensive treatment and severe hypoglycemia among adults with type 2 diabetes. JAMA Intern Med 2016;176:969-978
  9. McCoy RG, Van Houten HK, Ross JS, et al. HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study. BMJ 2015;351:h6138
  10. Some Older Patients Are Treated Not Wisely, but Too Much [Internet]. Available from
  11. Tseng CL, Soroka O, Maney M, Aron DC, Pogach LM. Assessing potential glycemic overtreatment in persons at hypoglycemic risk. JAMA Intern Med 2014;174:259–268
  12. Zoungas S, Chalmers J, Neal B, et al.; ADVANCE-ON Collaborative Group. Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N Engl J Med 2014;371:1392–1406

Hypoglycemia Occurrence and Risk Factors

  1. Barnett AH, Cradock S, Fisher M, et al. Key considerations around the risks and consequences of hypoglycaemia in people with type 2 diabetes. Int J Clin Pract 2010;64:1121-1129
  2. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011;365:2002–2012
  3. Feil DG, Rajan M, Soroka O, Tseng CL, Miller DR, Pogach LM. Risk of hypoglycemia in older veterans with dementia and cognitive impairment: implications for practice and policy. J Am Geriatr Soc 2011;59:2263-2272
  4. Karter AJ, Warton EM, Lipska KJ, et al. Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use. JAMA Intern Med 2017;177:1461-1470
  5. Lash RW, Lucas DO, Illes J. Preventing hypoglycemia in type 2 diabetes. J Clin Endocrinol Metab 2018;103:1265-1268
  6. Lipska KJ, Ross JS, Wang Y, et al. National trends in U.S. hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999 to 2011. JAMA Intern Med 2014;174:1116–1124
  7. Lipska KJ, Warton EM, Huang ES, et al. HbA1c and risk of severe hypoglycemia in type 2 diabetes: the Diabetes and Aging Study. Diabetes Care 2013;36:3535-3542
  8. Miller ME, Bonds DE, Gerstein HC, et al.; ACCORD Investigators. The effects of baseline characteristics, glycaemia treat­ment approach, and glycated haemoglobin concentration on the risk of severe hypogly­caemia: post hoc epidemiological analysis of the ACCORD study. BMJ 2010;340:b5444
  9. Pathak RD, Schroeder EB, Seaquist ER, et al.; SUPREME-DM Study Group. Severe hypoglycemia requiring medical interven­tion in a large cohort of adults with diabetes receiving care in U.S. integrated health care delivery systems: 2005–2011. Diabetes Care 2016;39:363–370
  10. Punthakee Z, Miller ME, Launer LJ, et al.; ACCORD Group of Investigators; ACCORD-MIND Investigators. Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial. Diabetes Care 2012;35:787–793
  11. Sarkar U, Karter AJ, Moffet HH, et al. Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: the Diabetes Study of Northern California (DISTANCE). J Gen Int Med 2010;25:962-968
  12. Shehab N, Lovegrove MC, Geller AI, et al. US emergency department visits for outpatient adverse drug events, 2013-2014. JAMA 2016;316:2115-2125

A1C Targets and Measurement

  1. Aron DC, Pogach LM. One size does not fit all: the need for a continuous measure for glycemic control in diabetes. Jt Comm J Qual Patient Saf 2007;33:636-643
  2. Laiteerapong N, Cooper JM, Skandari MR, et al. Individualized glycemic control for U.S. adults with type 2 diabetes: a cost-effectiveness analysis. Ann Intern Med 2018;168:170-178
  3. Schroeder EB, Karter AJ. Brief commentary: glycemic targets for older adults with type 2 diabetes. Ann Intern Med 2018
  4. Shepard JG, Airee A, Dake AW, et al. Limitations of A1c Interpretation. South Med J 2015;108:724-729.


  1. Miles DRB. Brief commentary: social determinants of health and treatment targets for type 2 diabetes. Ann Intern Med 2018
  2. Sarkar U, Fisher L, Schillinger D. Is self-efficacy associated with diabetes self-management across race/ ethnicity and health literacy? Diabetes Care 2006;29:823–829
  3. Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES par­ticipants. J Nutr 2010;140:304–310
  4. Tjia J, Velten SJ, Parsons C, et al. Studies to reduce unnecessary medication use in frail older adults: a systematic review. Drugs Aging 2013;30:285-307