Outpatient Hypoglycemia Measures May Enhance Care for High-Risk Patients with Diabetes

December 16, 2019

A set of performance measures for older adults with type 2 diabetes at greater risk for hypoglycemia published by the Endocrine Society and Avalere Health.

Outpatient hypoglycemia measures can greatly enhance care for patients with diabetes, according to a new report published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.1

The report contains the first-ever quality measures aimed to help health care providers identify and care for older patients with diabetes who are at greater risk for hypoglycemia. A part of Hypoglycemia Prevention Initiative launched by the Endocrine Society and Avalere Health, the quality measures were created by a panel of diabetes experts and focused on outpatient treatment for patients who are 65 and older and have type 2 diabetes.2

The panel included a mix of endocrinologists, primary care physicians, diabetes educators, pharmacists, measurement experts, and patient advocates.

Based on self-reporting, approximately 50% of individuals with type 2 diabetes experienced any episodes of hypoglycemia and 9% experienced severe hypoglycemia within 1 month of monitoring in a recent global study.1

“Currently, there are a limited number of hypoglycemia measures available in the United States,” the authors wrote in the report.1 “As such, the Society has developed these measures as a starting point to assess patients to determine if they are at greater risk for hypoglycemia.”

Patients at greater risk for hypoglycemia are among those who may need additional help with managing their disease, and pharmacists are well-positioned to offer specific counseling and education on reducing future hypoglycemic events.

According to the quality measures, the key risk factors that raise a patient’s chance of developing hypoglycemia include:1

  • Experiencing a hypoglycemia event where blood glucose levels dropped below 54 mg/dL and required immediate attention within the past year.

  • Experiencing altered mental or physical status requiring assistance during a severe hypoglycemia event in the past year.

  • Among individual who manage their blood sugar with insulin or medicines like sulfonylureas that increase the risk of hypoglycemia:
  • A documented A1c of less than 7% in the past 6 months, or

  • At least 1 other relevant chronic medical problem.

In addition, the report highlights the importance of patient education to minimize the risk of future hypoglycemia events, including education about signs, symptoms, and treatment.

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Providers can discuss any of the following with patients or caregivers:1

  • Directed or targeted education which includes discussion of hypoglycemia signs, symptoms, treatment, and recommendations.

  • Hypoglycemia awareness and management.

  • Diabetes self-management education and support.

  • Blood glucose awareness training

  • Medication management, which includes glucagon use.

“Engagement with a caregiver may also be necessary, especially in situations where the patients has disabilities, frailty, or cognitive deficits,” the authors wrote.1

Another measure seeks to capture information on whether patients who are identified as being at greater risk for hypoglycemia report experiencing symptoms associated with a Level 3 hypoglycemia event during a 12-month period. Level 3 hypoglycemia is defined as “a severe event characterized by altered mental and/or physical status requiring assistance.”1

Through this self-reporting, the provider can identify the type of intervention that will be most successful at helping the patient avoid future episodes of hypoglycemia, according to the report.1

Overall, the authors noted that research is required to identify other measures that may help further improve the quality of care for patients with type 2 diabetes who are at greater risk for hypoglycemia. Other potential areas for measurement include use of patient-generated data, specific adjustments to medications, and the impact of transitions of care on hypoglycemic events.1

 

 

References:

1. Rosenzweig JL, Conlin PR, Gonzalvo JD, et al. 2019 Endocrine Society measure set for older adults with type 2 diabetes at risk for hypoglycemia. 2019. Journal of Clinical Endocrinology & Metabolism. 

2. First-ever quality measures aim to reduce diabetes complications [news release]. Endocrine Society’s website. https://www.endocrine.org/news-and-advocacy/news-room/2019/first-ever-quality-measures-aim-to-reduce-diabetes-complications. Accessed December 16, 2019.