Observations of Glucagon-Prescribing Patterns for High-Risk People With Diabetes Within a Federally Qualified Health...

Hypoglycemia is a serious complication in people with diabetes. Risk factors include increased age, certain comorbidities, and certain glucose-lowering medications. Although the American Diabetes Association recommends prescribing glucagon to individuals at high risk for hypoglycemia for use in emergent episodes, glucagon use remains low. This is particularly concerning in federally qualified health centers (FQHCs), where patients face socioeconomic barriers that may exacerbate this gap in care. This study evaluated glucagon-prescribing rates among high-risk patients with diabetes in a FQHC.

A retrospective chart review was conducted of patients with diabetes seen between March 2022 and March 2023 who were prescribed a high-risk medication and/or had a history of hypoglycemia. Demographics and clinical characteristics such as history of hypoglycemia, high-risk medications, and active glucagon prescriptions were analyzed using descriptive statistics and comparative tests to determine characteristics associated with glucagon prescriptions.

Of the 7,304 patients, 95% had type 2 diabetes, and 61.5% were prescribed insulin, but only 4.4% had an active glucagon prescription. Among 65 individuals with documented hypoglycemia, 80% were prescribed a high-risk medication, yet only 13.8% were prescribed glucagon. Patients with type 1 diabetes were more likely to have glucagon prescribed (P = 0.002).

Glucagon was significantly under-prescribed in this high-risk population, highlighting gaps in applying clinical guidelines to practice as well as gaps in access to preventive care. These findings will inform provider education and interventions to improve glucagon-prescribing practices.