Diabetes, gabapentinoids, and high-value care

This issue covers some clinical dilemmas and offers insights into the value of care.

Diseases don't get much more common than diabetes, but that doesn't mean the condition is easy to manage. This month's main story looks at how inpatient diabetes care is becoming ever more complicated thanks to an expanding array of drugs and technologies available outside the hospital. As more patients are admitted with insulin pumps or prescriptions for new drug classes, hospitalists will have to figure out how to manage these regimens during their stays. Experts offer their advice.

This issue also tackles another challenge emanating from outpatient care: use of gabapentinoids to treat pain. Prescriptions for these drugs tripled between 2002 and 2015, mostly as a response to the opioid epidemic, and while the goal of reducing opioid prescribing is laudable, the article on page 10 explains that gabapentin and pregabalin pose issues of their own, including increased risk of falls and fluid retention.

Multiple articles in this issue focus on the value of care. First up is a historical perspective on insurance coverage and hospital utilization. It's more interesting than it sounds, I promise! And it's important to understand as the presidential candidates debate their plans for the health care system.

On the same theme, our conference coverage focuses on how to increase the value of care in your own hospital. We've got tips on implementing high-value projects and evidence for skipping stress tests and venous thromboembolism prophylaxis in low-risk patients, as well as advice on using sedation and paralysis appropriately in the ICU.

Have advice of your own to share? Email us anytime at acphospitalist@acponline.org.

Stacey Butterfield