Hypoglycemia Safety Initiative (HSI) - Quality, Safety & Value
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Hypoglycemia Safety Initiative (HSI)

Choosing Wisely® is a collective effort among professional societies whose goal is to reduce medical tests, treatments, and procedures that may be unnecessary. The Veterans Health Administration (VHA) has embraced this initiative, which has included establishing the Choosing Wisely Hypoglycemia Safety Initiative (CW-HSI).


The VHA CW-HSI targets a concern first addressed by VA/Department of Defense Guidelines for Diabetes in 1997. Led by Drs. Len Pogach, Brian Burke, and Sandra Hedin, the VHA CW-HSI is a multi-disciplinary effort that welcomes input from several VHA Program Offices: Patient Care Services, Nursing Services, Pharmacy Services, Nutrition & Food Service, and the National Center for Health Promotion and Disease Prevention. Hypoglycemia is also recognized as a national health problem by the Department of Health and Human Services (HHS), which itself has developed a National Action Plan for Adverse Drug Event Prevention in collaboration with VA and other federal health agencies.

Approximately 50 percent of Veterans with diabetes being treated with medications have comorbidities that increase their risk of serious hypoglycemia including advanced age, renal dysfunction, diabetic complications, cognitive impairment, and other serious medical or mental health conditions. About 50 percent of these Veterans have laboratory evidence of intensive management (A1C <7%) that increases their risk of hypoglycemia without significant treatment benefit.

The VHA CW-HSI proposes a voluntary program to improve patient-centered care. The program reaches both Veterans and their health care teams, providing them with the necessary tools and resources to help effect change. Although CW-HSI is an internal (VHA) effort, we hope that all clinicians will recognize the importance of improving safety for patients at risk for hypoglycemia and consider adopting similar initiatives in the non-Veteran population. Ultimately, the goal of these efforts is to foster evidence-based, patient-centered, critical clinical thinking and shared informed decisions between health care teams, clinicians, and patients.

Want to learn more? Patients, click here for information on hypoglycemia (low blood sugar), the A1C test, medication safety, food insecurity, and shared decision-making. Clinicians, click here for patient care resources.