The American Diabetes Association recommends that patients at high risk for hypoglycemia be prescribed glucagon.
Using de-identified administrative claims from OptumLabs® Data Warehouse (OLDW) for commercial and Medicare Advantage enrollees, we examined glucagon prescriptions filled between 1/1/2014 and 12/31/2014 among pharmacologically treated type 1 and 2 diabetes patients. We examined association of glucagon fills with demographic, clinical, and laboratory-based factors. HbA1c levels were available for a subsample. Model performance was assessed with AUC and calibration plots.
Among 12,338 patients with type 1 and 323,244 with type 2 diabetes, 14.5% and 0.7% filled glucagon in 2014, respectively. Among type 1 diabetes patients, the multivariable model had poor discriminative performance (AUC=0.61). Among patients with type 2 diabetes, the model AUC was 0.89. Factors associated with glucagon use are shown in Figure. HbA1c level was not independently associated with glucagon fills.
In this national study, glucagon was rarely filled.
Among patients with type 1 diabetes, glucagon fills were unpredictable and not targeted to highest risk patients. Patients with type 2 diabetes were more likely to fill glucagon in the setting of prior hypoglycemia, higher income, and endocrinology care. These findings suggest opportunities to improve care, including better prescribing practices to target high-risk patients.
P. Kahn: None. S. Liu: None. R.G. McCoy: None. R.A. Gabbay: Advisory Panel; Self; FormHealth, Health Reveal, Lark, Onduo, Vida Health. K.J. Lipska: None.
National Institutes of Health (K23AG048359)