Strategies to Reduce Iatrogenic Hypoglycemia and Hypotension in Vulnerable Older Adults

Overtreatment of diabetes mellitus and hypertension resulting in iatrogenic hypoglycemia and hypotension are especially common in vulnerable older adults and can result in excess morbidity, mortality, and health care costs. In this article, we review the prevalence of these conditions and the incidence of their complications. We recommend that physicians who provide primary and specialty care, as well as advanced practice practitioners (nurse practitioners and physician associates) who write prescriptions and orders for these treatments be incentivized to avoid these harms through carefully designed quality measures (QMs) and other strategies. We list several general and specific recommendations for strategies that we believe have the potential to reduce the incidence of iatrogenic hypoglycemia and iatrogenic hypotension and related complications in vulnerable older adults. Collaboration among health care organizations and facilities, health policy makers, professional organizations, individual health care providers, researchers, and patients will be essential in achieving this potential.