Introduction: Hypoglycemia is a major barrier to optimal glycemic control and is a significant cause of morbidity and mortality in patients with diabetes. Additionally, hypoglycemia accounted for 235, 000 emergency department visits in 2016 according to the CDC. The ADA recommends that glucagon should be prescribed for all patients at increased risk of level 2 or 3 hypoglycemia so that it is available should it be needed. We hypothesize that glucagon is under-prescribed in patients with diabetes who are on prandial or premixed insulin at a tertiary center teaching hospital.

Methods: We performed a retrospective observational study of patients seen at an outpatient clinic at a tertiary center teaching hospital from February 2020 to July 2021. We chart audited 482 patients seen at least 3 times at the clinic with the diagnosis of diabetes on their electronic medical record. We included only patients who were on prandial or premixed insulin. We performed an analysis looking at the rate of glucagon prescription in the clinic.

Results: A total of 1patients were included in our final analysis with mean age [standard deviation] of 56.86[13.13], 44.1% Female, 66.6% African American, BMI of 33.62[9.92], HbA1C of 9.07[2.08], and 96.4% had health insurance. Only 5 patients (4.5%) of the qualified cohort were prescribed glucagon at our clinic.

Conclusion: Glucagon is under-prescribed at our clinic, with only 4.5% of the qualified cohort being prescribed glucagon. This rate is significantly lower than a previously published study showing a rate of 28%. Health insurance is unlikely to be a contributing factor. This could be due to a knowledge gap among providers about the standards of diabetes care guidelines. An educational intervention to help improve the prescription rate of glucagon and potentially decrease the hypoglycemia burden is warranted.


T.Abdulwahid: None. J.Lloyd: None. K.Selk: None.

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