Quality Improvement Initiatives Could Help Increase Glucagon Prescribing
A study found that sending a letter to providers about standards of care and glucagon preparations could increase glucagon prescription rates.
Provider engagement through quality improvement initiatives could help increase glucagon prescribing for patients with hypoglycemia using continuous glucose monitors (CGM), new research published in the journal Endocrine Practice found.1 The authors said more studies are needed to better understand factors that are affecting glucagon prescription behavior.
Quality Improvement Initiatives Could Help Increase Glucagon Prescribing / goodmanphoto - stock.adobe.com
Hypoglycemia is a common complication in patients with diabetes that can lead to organ failure, coma, and death. Glucagon, which is recommended by the American Diabetes Association (ADA) in its Standards of Care for all patients at high risk of hypoglycemia, can potentially reverse the life-threatening complication.2 However, glucagon prescription rates for patients who are at-risk of hypoglycemia remain low.
READ MORE: Q&A: Challenges, Barriers Impacting Glucagon Prescribing
“Despite its life-saving capability, [glucagon] prescription is almost an afterthought in the grand scheme of diabetes management,” the authors wrote. “Historically, prescription rates for patients at risk of hypoglycemia has been low both in the emergency room setting (3%) as well as outpatient clinic (30%). Even when prescribed, the fill rate continues to be concerning as demonstrated in a large sample of Medicare beneficiaries with diabetes from 2011 to 2021.”
A team of investigators from the Cleveland Clinic conducted a study to assess the percentage of glucagon prescriptions in patients with hypoglycemia on CGM and determine incident glucagon prescription after an educational letter delivered to their providers. The study included 2 components: a retrospective chart review and a quality improvement initiative.
The chat review was conducted from March to October 2023. The quality improvement initiative included sending a letter to providers about ADA standards of care and glucagon preparations if a patient’s CGM demonstrated a time below range of 4% or higher.
The study cohort included 1543 adult patients with either type 1 or 2 diabetes who were seen by endocrinology and primary care providers in Ohio at a tertiary care health system. Patients were included in the study if they had a CGM download and an ambulatory glucose profile at in-person or virtual visit. Patients were excluded if they had a condition that contraindicated the use of glucagon or if they had another type of diabetes.
Of the included patients, 170 had hypoglycemia, with 66 having mild hypoglycemia, 88 having moderate hypoglycemia, and 16 having severe hypoglycemia. Of those, 63 had a pre-existing glucagon prescription, 24 had incident prescription, and 9 had both pre-existing followed by incident glucagon prescription. Pre-existing or incident glucagon prescription were seen in 28% of patients without hypoglycemia.
The study found that, of the 70 providers who received educational letters about prescription of glucagon, 39% prescribed it. Of the types of providers, advanced practice providers were more likely to prescribe glucagon after receiving the educational letter compared to physicians and clinical pharmacists. The top 3 glucagon choices were glucagon emergency kit, Gvoke Hypopen, and Baqsimi.
“While we need to evaluate effective methods of increasing glucagon prescription, we also need future studies to determine factors affecting prescription practices,” the authors concluded. “Previous studies have shown that education on glucagon use was provided in 70% to 90% of the patients with T1D. This must be improved for patients with other types of diabetes and hypoglycemia. Larger studies need to be conducted to learn factors associated with prescription practices.”
READ MORE: Diabetes Resource Center
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