Most hypoglycemia ED visits don’t result in glucagon prescription

  • Fendrick AM & al.
  • Endocr Pract
  • 23 Jul 2018

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Guidelines call for glucagon prescriptions for diabetes patients at increased risk for clinically significant hypoglycemia.
  • Glucagon prescriptions may prevent future emergency department (ED) visits. 

Why this matters

  • Insulin-related hypoglycemia accounts for nearly 100,000 US ED visits annually, with 30% resulting in admissions.

Study design

  • Retrospective study of glucagon prescriptions filled after an ED visit for hypoglycemia during January 2011 to June 2014 by 3177 people with type 1 diabetes (T1D) and 10,567 insulin-treated type 2 diabetes (T2D) patients who did not already have an unexpired glucagon prescription within the Truven Health MarketScan Research Database.
  • Funding: Eli Lilly and Company.

Key results

  • Only 10.9% with T1D and 3.5% with T2D filled glucagon prescription within 90 days of ED hypoglycemia visit.
  • ED readmissions for hypoglycemia within 30 days of prior visit:
    • 9.2% with T1D; 
    • 11.2% with T2D.
  • Percentages filling basal-bolus insulin prescriptions or on commercial insurance were significantly higher with those who did vs did not fill glucagon prescriptions.
  • Percentages of people with T1D ≤18 years and with T2D ≥65 years were higher among those who filled glucagon vs those who did not.

Limitations

  • Limitations of insurance claims research, eg, coding errors, incomplete data.
  • Assessment limited to prescriptions filled, not ordered.

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