Glitazone in Diabetes
Relationship to patient dual public/private sector use
- Christine M. Heckemeyer, MD12 and
- Catarina I. Kiefe, MD, PHD123
- 1National Quality Scholars Program, Birmingham VA Medical Center, Birmingham, Alabama
- 2Deep South Center on Effectiveness, Birmingham VA Medical Center, Birmingham, Alabama
- 3Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Address correspondence to Christine M. Heckemeyer, MD, BVAMC Annex, Room 203, Mailbox no. B61, Birmingham VA Medical Center, 700 South 19th St., Birmingham, AL 35233. E-mail: christine.heckemeyer{at}med.va.gov
In its evidence-based guidelines for type 2 diabetes (1), the Veterans Health Administration (VHA) recommends a second-generation sulfonylurea or metformin as first-line drug therapy. Metformin or sulfonylurea is added to the first agent if HbA1c (A1C) control is not satisfactory. Because of their modest effect on A1C, unknown long-term safety, and high cost, the VHA recommends reserving thiazolidinediones (glitazones) for selected patients. We compared community versus Veterans Affairs (VA) primary care providers regarding initiation of glitazone therapy and presence of contraindications in veterans, who frequently obtain care both within and outside the VHA.
Glitazone prescription at the Birmingham VA Medical Center (BVAMC) required …
