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

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.