Leveraging Continuous Glucose Monitoring Data as an Additional Source for Glucagon Prescription Behavior

Abstract

Objective

Hypoglycemia can be life-threatening for patients with diabetes. We aimed to 1) evaluate percentage of glucagon prescription in patients with hypoglycemia on continuous glucose monitoring (CGM) reports, and 2) determine incident glucagon prescription after an educational letter delivered to the providers.

Research Design and Methods

The study had 2 components – retrospective chart review and a quality improvement (QI) component. Chart review was conducted from March to October 2023 on adult patients in a tertiary care health system with type 1 diabetes or type 2 diabetes on insulin, sulfonylurea, or meglitinide. Percentages of pre-existing and incident glucagon prescription were evaluated. For the QI, we contacted providers whose patients had hypoglycemia defined as time below range ≥ 4% on CGM reports without a glucagon prescription and shared the American Diabetes Association Standards of Care on hypoglycemia along with information about various forms of glucagon. Data on glucagon prescription were collected 4 weeks later.

Results

Of the 1543 patients included, 170 had time below range ≥4%. Among them, 37% had pre-existing prescription and 14% incident glucagon prescription, compared with patients without hypoglycemia (P < .001). Pre-existing or incident glucagon prescription was seen in 28% without hypoglycemia, 38% with mild, 49% with moderate, and 63% with severe hypoglycemia (P < .001 mild vs severe; moderate vs no hypoglycemia; and severe vs no hypoglycemia). Among 70 patients whose providers received education, 27 (39%) prescribed glucagon. Glucagon emergency kit, glucagon autoinjector, and inhaled glucagon were top choices.

Conclusion

Glucagon prescription remains suboptimal among patients with hypoglycemia on CGM reports. Provider engagement via QI can increase glucagon prescription.