Glucagon Prescribing Not in Full Alignment With ADA Guidelines | ADA 2025
The most frequent barriers to access to glucagon include cost, patient health literacy, and insurance coverage.
Investigators find that current practices among pharmacists are not fully in alignment with American Diabetes Association (ADA) guideline recommendations for glucagon use, with frequently identified barriers including cost, patient health literacy, and insurance coverage.
The most frequent barriers to access to glucagon include cost, patient health literacy, and insurance coverage. | Image Credit: Kalyakan - stock.adobe.com
In a poster session at the ADA 85 Scientific Sessions, the presenter recommendations for glucagon use should be prescribed for individuals taking insulin or at high risk for hypoglycemia. However, the prescription fill rates were low for patients with Medicare Advantage or those who were commercially insured, with only 9.7% of patients on a short-acting insulin and 2.3% on long-acting insulin only receiving a glucagon fill. In the study, the investigators aimed to determine the current practices and barriers to pharmacist-led outpatient glucagon use for patients with diabetes.
In the pilot survey, there were 6 clinical pharmacists with expertise in diabetes, and the final survey included 1624 members of the American College of Clinical Pharmacy Ambulatory Care and Endocrine and Metabolic Practice and Research Networks. Respondents included were included over 6 weeks from December 16, 2024, to January 27, 2025, and had the ability to prescribe or recommend glucagon in outpatient settings. The primary end points included outpatient prescribing and barriers to pharmacist-led outpatient glucagon use, and the secondary outcome was options and knowledge related to the use of glucagon.
In total, there were 186 respondents, with 75.2% being women; 38% were from the Midwest, 20.1% were from the Northeast, 24% were from the South, and 16.9% were from the West. Further, 83.1% were in primary care, 9.1% were in endocrinology, and 7.7% were in another practice setting.
Pharmacists in endocrinology were more likely to recommend or prescribe glucagon compared with those in primary care clinics, and the most commonly perceived barrier was cost for both groups. For clinicians, they were most concerned with insurance coverage (68%), resources for education (50%), guidance on appropriate prescribing (42%), training on education (33%), collaborating provider’s knowledge (29%), and data on cost-effectiveness (20%). For patient-specific concerns, the biggest barriers were cost (76%), when to use health literacy (72%), how to use health literacy (56%), treatment burden (37%), and adverse events (6%).
Respondents were most likely to prescribe glucagon for patients with type 1 diabetes on basal and bolus insulin and least likely to prescribe it for patients with type 2 diabetes, type 2 diabetes on secretagogues, or type 2 diabetes on basal insulin only, with the latter being the most in contrast to the ADA guidelines. Respondents were more likely to adhere to the guidelines for patients with type 1 diabetes, patients with type 2 diabetes who were on basal and bolus insulin, or patients with type 2 diabetes on an insulin pump. Furthermore, pharmacists in endocrinology clinics were more likely to prescribe glucagon according to ADA guidelines.
Lastly, the respondents discussed the types of glucagon formulations and their awareness. Pharmacists in endocrinology were the most aware of all the different formulations but were not as aware of liquid-stable, prefilled syringes. Pharmacists in primary care were most familiar with nasal sprays and liquid-stable autoinjectors and least familiar with vials of glucagon powder and diluent and liquid-stable, pre-filled syringes.
The investigators concluded that there needs to be increased awareness of guideline recommendations for glucagon use as well as available options and that cost and insurance continue to be the most significant barriers to care. Further, pharmacists should consider how routine glucagon prescribing should be prioritized according to the ADA recommendations.
Read more from our coverage of the ADA’s 85th Scientific Sessions.
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