Q&A: Challenges, Barriers Impacting Glucagon Prescribing
Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, discusses the benefits of glucagon and why pharmacists should be able to prescribe it.
The American Diabetes Association (ADA) recently released its updated Standards of Care, in which it is recommend that all patients taking insulin or those who are at high risk for hypoglycemia be prescribed glucagon.1 The organization also recommends that family members, caregivers, school personnel, and others who provide support to patients with diabetes be educated on how to administer glucagon and where it is located in case of emergency.
Q&A: Challenges, Barriers Impacting Glucagon Prescribing / abcmedia - sto k.adobe.com
In an article published in Clinical Diabetes, Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences, and Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, director of education and training in diabetes technology at Cleveland Clinic, discussed the ADA's new Standards of Care and the benefits of allowing pharmacists to prescribe glucagon.2
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In an interview with Drug Topics, Goldman discussed the benefits of glucagon for patients with diabetes, challenges and barriers currently impacting glucagon prescribing, and how allowing pharmacists to prescribe glucagon could improve rates of prescribing and filling.
Drug Topics: What are the benefits of prescribing glucagon to patients with diabetes?
Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP: Most important is lifesaving potential. Ready-to-use glucagon provides a rapid intervention for severe hypoglycemia, especially when a person is unable to self-administer carbohydrates. I always tell patients that if you're in fear and you're alone, it is important for you to treat yourself. Same thing with their family members around them. Do not wait for unconsciousness.
We have improved accessibility now. We have new glucagon formulations. This is what's recommended by all accrediting bodies, all diabetes bodies across the world, including the American Diabetes Association. There's new, updated, 2025 guidelines that just came out, including the recommendation for ready-to-use glucagon. When I say that, what I mean is the intranasal or the auto-injectors. It's allowed for really ease of use for non-medical provider. You don't need to reconstitute it. There's no needles you have to attach. That's what we should be recommending. By having this available in easy to use [formulations] for patients and caregivers, it brings peace of mind and really increased confidence to that family or to that patient. It reduces that fear of severe episodes and empowers them to respond effectively and that enhances our outcomes. It really does reduce the risk of hospitalizations and those associated complications.
Drug Topics: Rates of glucagon prescriptions remain low. What are the current challenges or barriers preventing higher rates of glucagon prescribing?
Goldman: Among healthcare providers and patients about the importance of ready-to-use glucagon, there seems to be a lack of awareness. There's a lack of awareness on the updated guidelines and recommendations. There's also a lack of awareness on these new products that are available, that are easy to use, that are in that auto injector ready to use form, as well as the intranasal form. We need to make sure that we have healthcare provider awareness, but patient awareness also, Many patients are unaware that glucagon even exists or understand the importance of it.
Some other limitations might be the high cost and affordability, but insurance coverage is excellent for both of these available formulations. It’s outdated practice and not recommended to be using those older, more cumbersome formulations, like glucagon that has to be reconstituted. We really need to be recommending the ready to use glucagon. And the other thing is making sure the storage is known. Sometimes patients will find that they go to get it and it's expired. The newer formulations do have a longer shelf life.
Drug Topics: How would giving pharmacists prescriptive authority for glucagon improve rates of prescribing and filling?
Goldman: Allowing pharmacists to prescribe glucagon is something near and dear to my heart that I would absolutely recommend. Similar to when we think about what happened with Narcan to save people's lives, we really could have wider access. Pharmacists can identify at-risk patient and provide prescriptions on site, so bypassing the need for additional appointments. They often have more accessibility than physicians do, and that could reduce the delay in obtaining prescriptions at that point of care, because pharmacists are often that last touch point before they go home. They spend more time in the pharmacy than they necessarily do in their doctor's office. That pharmacist could provide and train patients on the use of glucagon at the time of dispensing. Pharmacists can provide hands on guidance about the glucagon and ensure patients understand its importance.
If they're filling a prescription somebody gets for insulin or they find out a patient that has a history of hypoglycemia right on the spot, being able to prescribe that can truly save people's lives. It also helps that pharmacists are in a position to be able to identify at risk patients and make those recommendations and have those timely prescriptions. It's also convenient. It's convenient for that patient, so that they have access to glucagon at a pharmacy visit when they're at the pharmacy. I think that that would drive a big public health impact. The pharmacy driven initiatives can normalize glucagon use and raise awareness about severe hypoglycemia and potentially save lives.
READ MORE: Diabetes Resource Center
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