Pharmacist-Led Hypoglycemia Prevention Leads to Safer Prescribing in Diabetes

Proactive and protocol-driven outreach to clinical pharmacists resulted in safer prescribing of diabetes medications among patients with type 2 diabetes (T2D) at high hypoglycemia risk, according to a study in JAMA Network Open.¹ The pharmacist’s role was found to lead to patient safety enhancements and the potential reduction of health care costs.

“Despite its clinical importance, hypoglycemia risk is often underrecognized and undertreated in routine care, partly because severe hypoglycemia is most frequently treated outside of the medical system, and traditional glycemic targets emphasize hemoglobin A_1c (HbA_1c) control rather than minimizing glucose variability or preventing iatrogenic hypoglycemia,” wrote the authors of the study. “To our knowledge, there have been no published studies of proactive, guideline-based, and pharmacist-led interventions to reduce diabetes medication risk.”

With pharmacists on the front lines in their communities, they have—especially since the COVID-19 pandemic—stepped up in recent history to significantly manage and improve patient outcomes for those on a variety of medication regimens. Indeed, a previous study in Diabetes, Metabolic Syndrome, and Obesity found that the pharmacist’s expertise is paramount in the delivery of high-quality care.²

READ MORE: CGM Plays Key Role in Pharmacist-Led Diabetes Care

Despite the study being focused within the context of ambulatory care, pharmacists have increasingly displayed their ability to rise as authorities on medication management, specifically for conditions like diabetes and cardiovascular disease.³ Furthermore, highlighting their skills in understanding patients’ medications, pharmacists have even been reported to increase prescribing rates significantly, according to a JAPhA study that detailed pharmacist-led prescribing between 2019 and 2023.⁴

Although a myriad of data has solidified the pharmacist’s role in medication management, their prescribing abilities are still significantly minimal across the US. Despite all 50 states allowing pharmacists to prescribe in some capacity, these authorizations are typically reserved for overdose-reversing agents, contraceptives, HIV treatment, and smoking cessation.^5-6

Amid these ongoing trends in the greater pharmacy landscape, as well as within diabetes and hypoglycemia management, researchers of the current study wanted to further explore the pharmacist’s ability to improve diabetes medication safety through an evidence-based algorithm called Hypoglycemia on a Page (HOAP).¹

“The HOAP algorithm provides guidance on medication regimen changes, glycemic target resetting, use of continuous glucose monitoring, glucagon prescribing, tailoring patient education, and adding hypoglycemia to the patient’s problem list,” they wrote. “We then conducted a randomized clinical trial to evaluate whether proactive clinical pharmacist outreach, guided by the HOAP algorithm, would increase the proportion of patients with high risk prescribed safer diabetes regimens compared with usual care.”

In the trial they conducted, researchers included adult patients with T2D and high risk of hypoglycemia between July 20, 2023, and January 22, 2024. They were then randomized equally to the pharmacist intervention or a usual care arm that was constituted as the study’s control. Through the researchers’ intention-to-treat analysis, their main study outcome was the proportion of participants prescribed safer regimens, which was defined as discontinuation of sulfonylureas and/or rapid-acting or short-acting or mixed insulins.

The final analysis included 96 patients (mean age, 73.8 years; 54.2% women) in the HOAP group and 95 in the usual care arm (mean age, 68.7 years; 50.5% women).¹

After 6 months of the study, patients in the intervention arm (28.1%) were significantly prescribed safer medications compared with the control arm (15.8%). There were also fewer hypoglycemia-related events in the intervention arm, and overall HbA_1c control was reported across the entire study population.

Patients with pharmacist-led focus on their diabetes regimens were twice as likely to experience safer medication use. With help from the HOAP algorithm, this study further highlights the pharmacist’s ability to deprescribe and induce improved outcomes for patients with T2D and hypoglycemia risk. Furthermore, with pharmacists’ continued deprescribing abilities amid their expanding scope of practice, a future where pharmacists prescribe diabetes medications is not unlikely.

However, in the meantime, researchers continue to bolster the pharmacist’s place within multidisciplinary health care teams through studies like these.

“This intervention improved medication safety without worsening glycemic control and resulted in fewer hypoglycemia-related acute care encounters,” concluded the authors.¹ “Embedding structured, pharmacist-led deprescribing strategies into team-based care is an effective, scalable approach to reducing treatment-related harm in populations at high risk.”

READ MORE: Diabetes Resource Center

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REFERENCES

1. Gilliam LK, Parker MM, Chen MW, et al. Pharmacist intervention for safer prescribing in patients with type 2 diabetes at high risk: a randomized clinical trial. JAMA Netw Open. 2026;9(2):e2559946. doi:10.1001/jamanetworkopen.2025.59946

2. Orabone AW, Do V, Cohen E. Pharmacist-managed diabetes programs: improving treatment adherence and patient outcomes. Diabetes Metab Syndr Obes. 2022 Jun 20;15:1911-1923. doi: 10.2147/DMSO.S342936.

3. Reidt S. Proof in the pudding: More pharmacists are prescribing. Surescripts. May 29, 2024. Accessed February 19, 2026. https://surescripts.com/insights/more-pharmacists-are-prescribing

4. Reidt S, Hsieh M, Roufael J, et al. Evaluating trends in pharmacist e-prescribing: 2019-2022. JAPhA. 2024;64(4):102092. https://doi.org/10.1016/j.japh.2024.102092

5. Evans A. Prescribing authority for pharmacists: rules and regulations by state. GoodRx. July 22, 2022. Accessed February 19, 2026. https://www.goodrx.com/hcp-articles/pharmacists/prescriber-authority-for-pharmacists

6. States can empower pharmacists to prevent and treat infectious diseases. National Conference of State Legislatures. December 9, 2025. Accessed February 19, 2026. https://www.ncsl.org/health/states-can-empower-pharmacists-to-prevent-and-treat-infectious-diseases