Choose This, not That
The "they" your patient referred to is an initiative called Choosing Wisely, created by the nonprofit American Board of Internal Medicine (ABIM) Foundation in conjunction with Consumer Reports. The organization has compiled a list, with input from various physician specialty societies, of common medical tests and treatments that are often unnecessary. A few examples include:
• A feeding tube in patients with advanced dementia (American Academy of Hospice and Palliative Medicine and American Geriatrics Society);
• A routine annual Pap test for women aged 30 years or older, or younger than 21 years (American College of Obstetricians and Gynecologists);
• Dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 years or men younger than 70 years, unless bone loss is suspected (American Academy of Family Physicians); and
• CT for a child with a minor head injury (American Academy of Pediatrics).
Combined, there are about 90 tests, treatments, and procedures that physicians should be wary of ordering routinely.
For diabetes care, the only recommendation thus far comes from the American Geriatrics Society, which advises clinicians to avoid a target A1c value less than 7.5% in adults older than 65 years, as cited in the case above. Although none of the endocrine societies have contributed to the Choosing Wisely campaign, less aggressive glycemic control is consistent with guidelines from the American Diabetes Association, as well as other guidelines that suggest a more individualized approach to treatments and goals.
However, as a practicing physician who cares for many diabetic patients, I have several concerns regarding this campaign.