Excessive testing of adults with type 2 diabetes

When I began my medical training in 1980, I commonly encountered patients whose bodies were ravaged by end stage complications of diabetes. These patients often had marked visual impairment, debilitating neuropathy, myopathies, and diabetes related renal insufficiency, well before age 65 years. I still occasionally see such individuals, but they are rare, and tend to come from the 10-15% of patients who still have poor glycemic control. Improvement in diabetes care is a medical success story, but increasing evidence suggests that overly aggressive treatment is an under-appreciated problem.

In a linked study,1 McCoy and colleagues report that a cohort of patients with excellent glycemic control of their type 2 diabetes received glycated hemoglobin (HbA_1c) monitoring that exceeded recommended guidelines, and that this excessive testing was associated with excessive treatment. These results are yet another example of how prone our profession is to taking useful tests and treatments to excess. The common belief that there is “no harm in looking” continues to result in not just waste, but also palpable patient harm. The temptation to treat suboptimal numbers too often overrules more judicious judgments based on …