The Endocrine Society and the American Association of Clinical Endocrinologists have released a series of recommendations that advise against unnecessary tests and procedures in patient diagnosis and treatment.
More than 30 health organizations have released or will release treatment guidelines as part of the American Board of Internal Medicine Foundation’s "Choosing Wisely" campaign, which is meant to educate patients and physicians about unnecessary and potentially harmful testing and treatment. The recommendation lists, expected to be completed by early 2014, are part of a series that hopes to "spark conversations between patients and physicians about what care is really necessary for specific conditions."
The Endocrine Society and AACE recommended the following:
• Avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia. Such testing can be excessive for patients who are doing a good job of maintaining glycemic control, and testing results can become quite predictable. There are a number of exceptions, such as when a patient is sick or losing weight, or when new medications are added or hemoglobin A1c values stray from targets.
• Don’t routinely measure 1,25-dihydroxyvitamin D unless the patient has hypercalcemia or decreased kidney function. In vitamin D deficiency, 1,25-dihydroxyvitamin D levels go up, not down. Serum levels of 1,25-dihyroxyvitamin D are regulated primarily by parathyroid hormone levels and have little connection to vitamin D stores. When trying to assess vitamin D stores or diagnose vitamin D deficiency (or toxicity), 25-hydroxyvitamin D is the correct test.
• Don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland. Nodules detected via ultrasound are usually unrelated to the abnormal thyroid function and may divert the clinical evaluation to assess the nodules, rather than the thyroid dysfunction.
• Don’t order a total or free T3 level when assessing levothyroxine (T4) dose in hypothyroid patients, as the blood level of total or free T3 may be misleading. With most patients, a normal TSH indicates a correct dose of T4.
• Don’t prescribe testosterone therapy unless there is strong biochemical evidence of testosterone deficiency. Many of the symptoms attributed to male hypogonadism are common in the normal male aging process or are the result of a comorbid condition. In addition, testosterone therapy is expensive and has the potential for serious side effects in some patients. Total testosterone levels should be taken in the morning, and a low level should be confirmed on a different day.