Introduction and Objective: Severe hypoglycemia (SH) poses a significant threat to persons with diabetes, with evidence of 30-40% of patients with type 1 diabetes (T1D) and 1-in-5 individuals with type 2 diabetes (T2D) experiencing severe events annually. Alarmingly, prescriptions for ready-to-use (RTU) glucagon remain drastically low: 22.4% of patients at increased risk currently receive RTU glucagon. The objective of this study was to determine if providers’ RTU glucagon mindsets and prescribing behaviors are more proactive or reactive, and aligned to updated guidelines.Methods: A double-blinded quantitative survey was distributed to health care providers (HCPs) via email. Key inclusion criteria included that each HCP treated T1D and/or T2D patients, had ≥2 years of experience treating T1D/T2D patients with ≥75% time in direct patient care. A backward stepwise logistic regression with >40 characteristics was utilized to identify those with the highest predictive power for glucagon prescribing.Results: There were 242 U.S.-based respondents [96 Endocrinologists (Endo), 89 General Practitioners (GP), 57 Nurse Practitioners (NP)/Physician Assistants (PA)]. Though guidelines recommend all patients on insulin/insulin secretagogues are at increased risk of SH, most providers rely on personal experience/judgment in assessing patient risk and reactively prescribe RTU glucagon. The glucagon prescribing predictive model revealed 3 key patient characteristics: (1) history of lows/SH events; (2) T1D diagnosis; (3) on fast-acting insulin. The most predictive prescriber characteristic was provider type (Endo vs. GP or NP/PA).Conclusion: Our study emphasizes the urgent need for HCPs to shift from a reactive to a proactive, protective approach in prescribing RTU glucagon. Although HCPs are aware of guidelines, proactive discussions, recommendations, and prescribing of RTU glucagon is not applied to all populations at increased risk.
N. Ferguson: Employee; Xeris Pharmaceuticals, Inc. M.C. Devona: Employee; Xeris Pharmaceuticals, Inc. J.M. Meyer: Employee; Xeris Pharmaceuticals, Inc.
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