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

IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Practice Pub Date : 2024-10-25 DOI:10.1016/j.eprac.2024.10.012
Jayachidambaram Ambalavanan, Jill Rusticelli, Diana Isaacs, Huijun Xiao, James Bena, Christopher Babiuch, M Cecilia Lansang
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Abstract

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

Research design and methods: The study had two components - retrospective chart review and a quality improvement (QI) component. Chart review was conducted from March-October 2023 on adult patients in a tertiary care health system with type 1 DM, or type 2 DM 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 (TBR) ≥4% on CGM reports without a glucagon prescription and shared the ADA Standards of Care on hypoglycemia along with information about various forms of glucagon. Data on glucagon prescription was collected 4 weeks later.

Results: Of the 1,543 patients included 170 had TBR ≥4%. Among them, 37% had pre-existing prescription and 14% incident glucagon prescription, compared with patients without hypoglycemia (p<0.001). Pre-existing or incident glucagon prescription was seen in 28% without hypoglycemia, 38% with mild , 49% with moderate, and 63% with severe hypoglycemia (p<0.001 mild vs severe; moderate vs no hypoglycemia; 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.

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利用连续葡萄糖监测数据作为胰高血糖素处方行为的额外来源。
目的:低血糖可危及糖尿病(DM)患者的生命。我们的目的是:1)评估 CGM 报告中低血糖患者使用胰高血糖素处方的比例;2)确定向医疗服务提供者发送教育信后的胰高血糖素处方情况:研究包括两个部分:回顾性病历审查和质量改进(QI)部分。从 2023 年 3 月到 10 月,对一家三级医疗保健系统中患有 1 型糖尿病或 2 型糖尿病、正在使用胰岛素、磺脲类药物或格列汀类药物的成年患者进行了病历审查。我们评估了患者使用胰高血糖素前的处方比例和使用胰高血糖素后的处方比例。为了开展 QI,我们联系了在 CGM 报告中低血糖定义为低于量程时间 (TBR) ≥4% 但未开具胰高血糖素处方的患者的医疗服务提供者,并与他们分享了《美国糖尿病协会低血糖护理标准》以及有关各种形式胰高血糖素的信息。4 周后收集胰高血糖素处方数据:结果:在 1543 名患者中,170 人的 TBR ≥4%。结果:在纳入的 1543 名患者中,170 人的总血糖率≥4%,其中 37% 的患者有糖皮质激素处方,14% 的患者有胰高血糖素处方:在 CGM 报告的低血糖患者中,胰高血糖素处方仍未达到最佳水平。医疗服务提供者通过 QI 参与可增加胰高血糖素处方。
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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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