Implementing High-Value, Cost-Conscious Diabetes Mellitus Care Through the Use of Low-Cost Medications and Less-Intensive Glycemic Control Target: Comment on "Variation in Use of High-Cost Diabetes Mellitus Medications in the VA Healthcare System"

Type 2 diabetes mellitus (DM) is a leading cause of morbidity and mortality, affecting nearly 26 million people and costing $174 billion in the United States.¹ Monotherapy with oral agents lower hemoglobin A_1c (HbA_1c) levels an average of 1% of total hemoglobin. Combination therapy with a second oral medication or insulin leads to an additional 1% to 2% reduction. (To convert HbA_1cto a proportion of total hemoglobin, multiply by 0.01.) Most people with type 2 DM will receive more than 1 class of medication: 14% take both insulin and oral medications, and 58% take multiple oral DM medications.¹