Glucagon prescribing and prevention of hospitalization for hypoglycemia in a large health system

• Published in: Diabetes research and clinical practice Vol. 202; p. 110832
• Main Authors: Herges, Joseph R., Haag, Jordan D., Kosloski-Tarpenning, Kimberly A., Mara, Kristin C., McCoy, Rozalina G.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.08.2023
• Subjects: Adult; Diabetes; Diabetes Mellitus, Type 2 - complications; Female; Glucagon; Glucagon - therapeutic use; Hospitalization; Humans; Hypoglycemia; Hypoglycemia - drug therapy; Hypoglycemia - epidemiology; Hypoglycemia - prevention & control; Hypoglycemic Agents - therapeutic use; Retrospective Studies; Hospitalization; Diabetes; Glucagon; Hypoglycemia
• DOI: 10.1016/j.diabres.2023.110832
• ISSN: 0168-8227; 1872-8227

•Glucagon prescribing factors are unexplored utilizing an electronic health record.•Less than one-quarter of high-risk adults with diabetes were prescribed glucagon.•Having a glucagon prescription did not reduce hospitalization for hypoglycemia. To examine glucagon prescribing trends among patients at high risk of severe hypoglycemia and assess if a glucagon prescription is associated with lower rates of severe hypoglycemia requiring hospital care. Retrospective analysis of electronic health records from a large integrated healthcare system between May 2019 and August 2021. We included adults (≥18 years) with type 1 diabetes or with type 2 diabetes treated with short-acting insulin and/or recent history of hypoglycemia-related emergency department visit or hospitalization. We calculated rates of glucagon prescribing overall and by patient characteristics. We then matched 1:1 those who were and were not prescribed glucagon and assessed subsequent hypoglycemia-related hospitalization. Of 9,200 high risk adults, 2063 (22.4%) were prescribed glucagon. Among patients more likely to be prescribed glucagon were those younger, female, White, living in urban areas, with prior severe hypoglycemia, and with a recent endocrinology specialist visit. In the matched cohort (N = 1707 per arm), 62 prescribed glucagon and 33 not prescribed glucagon were hospitalized for hypoglycemia (adjusted incidence rate ratio 1.71, 95% CI 1.10–2.66; P = 0.018). Glucagon prescribing was infrequent with significant racial and rural disparities. Patients with glucagon prescriptions did not have lower rates of hospitalization for hypoglycemia.