Glucagon Prescription Patterns In Patients With Either Type 1 Or 2 Diabetes With Newly Prescribed Insulin

Mitchell, Beth; He, Xuanyao; Sturdy, Ian M.; Cagle, Andrew P.; Settles, Julie

doi:10.4158/ep15831.or

Cited by 35 publications

(29 citation statements)

References 30 publications

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“…Furthermore, a few previous reports suggest that glucagon therapy is unrecognized, undertaught and underutilized in general diabetic population despite recommendations and availability [9,11,12]. This study was based on patients' knowledge and possession of currently available glucagon injection kit in Croatia -GlucaGen ® Hypokit ® (Novo Nordisk A/S, Bagsvaerd, Denmark), a product in which glucagon is administered intramuscularly or subcutaneously.…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia and Glucagon Utilization in Insulin-Treated Diabetic Patients

Vilović

Kurir

Novak

et al. 2018

Exp Clin Endocrinol Diabetes

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Background First choice of therapy for severe hypoglycemia outside hospital environment is glucagon injection, an undertaught and underused remedy. Aim of this study was to investigate knowledge about glucagon therapy, possession rate and usage rate in insulin-treated diabetic patients, with special emphasis on history of hypoglycemia and severe hypoglycemia episodes. Methods In this cross-sectional study, 300 insulin-treated diabetic patients (146 males and 154 females, mean age 61.1±16.4 years) were recruited from comprehensive Diabetes Center in Croatia. Specialized self-administered, 13-item questionnaire regarding glucagon therapy and history of hypoglycemia was obtained from each patient, as well as data collected from medical history documentation. Results Experience of hypoglycemic episode was reported by 233 (77.7%), and severe hypoglycemia by 73 (24.3%) patients. Participants with experience of hypoglycemia have significantly longer diabetes duration (17.2±11.2 vs. 11.9±8.5 years, P<0.001) and lower BMI values (26.38±3.97 vs. 31.11±7.17 kg/m2, P<0.001). Knowledge about glucagon therapy had 55.3% patients, 44.7% obtained it from the pharmacy, while glucagon was used in 35.6% cases of severe hypoglycemia. Glucagon knowledge was better in patients that attended at least one diabetes lecture (P=0.038), while educational level showed no statistical significance (P=0.286). Main significant positive predictor of glucagon knowledge was history of severe hypoglycemia (OR 4.71, 95% CI 1.38 – 16.02, P=0.013). Conclusions Glucagon therapy was underused in treating severe hypoglycemia. It is highly important to emphasize value of quality education as one of the fundamentals of good diabetes management.

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Section: Introductionmentioning

confidence: 99%

Hypoglycemia and Glucagon Utilization in Insulin-Treated Diabetic Patients

Vilović

Kurir

Novak

et al. 2018

Exp Clin Endocrinol Diabetes

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“…A number of different studies, dating back to the 1950s, have evaluated the efficacy and safety of glucagon for severe hypoglycemia, administered either intravenously (IV), intramuscularly (IM), or subcutaneously (SC) [20][21][22][23][24][25][26] . The results have been remarkably consistent in demonstrating that glucagon administered IV, IM, or SC was safe, well-tolerated, and highly effective in restoring blood glucose levels and consciousness [15][16][17][20][21][22][23] . Per American Diabetes Association Guidelines for hypoglycemia: "Glucagon should be prescribed for all individuals at increased risk of level 2 hypoglycemia, defined as blood glucose <54 mg/dL (3.0 mmol/L), so it is available should it be needed 27 .…”

Section: Discussionmentioning

confidence: 79%

“…Despite being an important and effective treatment option for severe hypoglycemia, nearly one-third of adults with T1D report that they do not have a current glucagon prescription. Recent research 14 has suggested that: 85% of adults with T1D said they had been prescribed glucagon by a healthcare provider 68% of adults with T1D said they had a current glucagon prescription 18% of adults with T1D who received glucagon reported that it was administered without problems or errors Furthermore, Mitchell et al 15 found that both T1Ds and T2Ds who filled glucagon prescriptions, shortly after initiating insulin therapy, had fewer hypoglycemia-related ER visits than non-early glucagon counterparts, indicating the importance of early receipt and filling of glucagon prescriptions in insulin-dependent diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

“…Even among PWDs who have received a glucagon prescription, the persistency rates to refill a prescription remain low. Less than 50% of T1D and less than 1% of T2D patients renew prescriptions after 48 months Mitchell et al 15 Most PWDs who receive glucagon for treatment of severe hypoglycemia reported a host of problems about the experience 14 . While these findings may suggest the need for improvements in prescribing practices and patient/caregiver education on administration practices, they also indicate that better glucagon formulations that are simple to use and successfully deliver a full-dose of glucagon (high functional efficacy) may be needed in order to increase the use of glucagon in acute emergency situations.…”

Section: Introductionmentioning

confidence: 99%

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A ready-to-use liquid glucagon for treatment of severe hypoglycemia demonstrates reduced healthcare payer costs in a budget impact model

Leinwand

Johnsrud

Nguyen

et al. 2020

Journal of Medical Economics

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Research aim: To model the annual value of a novel ready-to-use, room-temperature stable liquid glucagon rescue pen and prefilled syringe (GRP, G-PFS; Xeris Pharmaceuticals, Inc.) for treatment of severe hypoglycemia events (SHE) versus current lyophilized powder glucagon emergency kits (GEK). GRP is a prefilled auto-injector designed to promptly administer concentrated liquid glucagon in a simple two-step process. G-PFS is a stable liquid formulation of glucagon in a prefilled syringe. In simulated emergencies, GRP and G-PFS demonstrated high functional efficacy, where 99% of users successfully administered a full-dose of drug. Studies with currently available injectable GEK suggest very low success rates (6-31%). The high functional efficacy of GRP and G-PFS significantly reduces user errors and may reduce utilization across emergency medical services (EMS), emergency departments (ED), and inpatient and outpatient costs for SHE. Methods: To estimate the economic impact of GRP and G-PFS, we developed a one-year budget impact model from a US commercial health plan perspective. Cost offsets from successful glucagon administration incorporated EMS, ED, inpatient, and outpatient utilization. Diabetes prevalence and event probabilities were estimated from publicly-available sources and clinical expert opinion. Costs

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“…The possession rate for glucagon among patients with T1D in Japan is reportedly very low (15.9%), mostly because patients do not think they will need glucagon, but also because of reluctance by family members to inject [9]. Higher glucagon possession rates have been reported in Australia (92%) [8], Israel (60%) [17], Croatia (45%) [18], and the USA (49%) [19]; this difference may reflect the lack of a glucagon kit in Japan, the older age of patients in this study (most other studies were of pediatric patients), or cultural factors. Because the NG device is ready to use and is less intimidating than using a syringe and needle for IMG injection, availability of the NG device may help increase the number of patients who keep glucagon on hand.…”

Section: Discussionmentioning

confidence: 99%

Usability of Nasal Glucagon Device: Partially Randomized Caregiver and Third-Party User Experience Trial with Simulated Administration at a Japanese Site

et al. 2019

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Introduction: Glucagon is the only approved medicine for severe hypoglycemia available for caregivers of people with diabetes. Nasal glucagon (NG) was recently approved in the USA as a needle-free, ready-to-use alternative to injectable glucagon. This simulated user experience study in Japan compared NG and intramuscular glucagon (IMG) administration by caregivers, and NG administration by untrained third parties. Methods: This was an open-label, single-center, partially randomized crossover, simulated user experience trial conducted in Japan (October 2018 to December 2018). Caregivers who live with and care for a relative with diabetes were randomized (1:1, stratified by patient diabetes type 1 or 2) to one of two simulated administration sequences (group 1: NG then IMG; group 2: IMG then NG). Caregivers received training on each device 2 weeks before simulated administration of the device. Third parties received no training and only conducted simulated NG administration. Outcome measures included the percentage of successful administrations (based on critical step completion and dose; primary outcome), time to complete administration, and user satisfaction/ preferences. Results: In caregivers (N = 19), the percentage of successful administrations was greater (89.5% vs 26.3%, P \ 0.001) and mean time to complete administration was shorter (23.9 vs 207.3 s, P \ 0.001) with NG than with IMG. In third parties (N = 20), 95% of NG administration attempts were successful (mean time to complete administration, 55.5 s). All caregivers and 80% of third parties reported that the NG device was easy to use. All caregivers and 70% of Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.9784958.

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Glucagon Prescription Patterns In Patients With Either Type 1 Or 2 Diabetes With Newly Prescribed Insulin

Cited by 35 publications

References 30 publications

Hypoglycemia and Glucagon Utilization in Insulin-Treated Diabetic Patients

Hypoglycemia and Glucagon Utilization in Insulin-Treated Diabetic Patients

A ready-to-use liquid glucagon for treatment of severe hypoglycemia demonstrates reduced healthcare payer costs in a budget impact model

Usability of Nasal Glucagon Device: Partially Randomized Caregiver and Third-Party User Experience Trial with Simulated Administration at a Japanese Site

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