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Adverse Events from Insulin Prescribing 'An Epidemic'

Cheryl Clark, for HealthLeaders Media, March 13, 2014

The results of a CDC study on insulin use errors suggest the need for a more individualized examination of which patients are prescribed insulin, with special attention to their life expectancy, level of frailty, and other diseases or conditions.

When clinicians look for ways to reduce healthcare-associated harm, how patients with diabetes are prescribed insulin is probably not at the top of their list.

Used by more than 5.3 million Americans with diabetes in a given year, the drug saves lives, preventing serious complications from diabetes such as amputations, kidney disease, and blindness.

But research this week from the Centers for Disease Control and Prevention shows the unexpected frequency with which insulin use errors—and often insulin overprescribing — cause blood sugar levels to drop too low, prompting a surprisingly high number of patients to rush to the emergency department. Almost a third of those patients require an inpatient admission.

The report should prompt a national re-examination of how doctors prescribe this important drug, how manufacturers package it, and how well patients and families are educated in the proper way to use it.

"We knew from previous work that insulin, which is a complex medication to manage, causes quite a few emergency room visits for adverse events," says Andrew Geller, MD, lead author of the paper published this week in JAMA Internal Medicine.

But what they didn't understand before the study was the high number of ED visits provoked by hypoglycemic episodes—about 100,000 a year, or 500,000 over the span of the five-year study that ended in 2011. That alone, Geller says, amounts to $600 million a year in ED treatment costs, much of it preventable.

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