Hypoglycemia continues to be a critical barrier for patients with diabetes to reach their goals. Hypoglycemic unawareness or fear of low blood sugar may lead these individuals to take less insulin than prescribed or for physicians to utilize oral medications that do not contribute to these events.
In an effort to understand these issues, the Endocrine Society conducted a comprehensive survey among its members to assess standard practices for diabetes education, how hypoglycemia may impact prescribing patterns, and ways in which formulary approvals may contribute to economic burdens on the healthcare system. The Society received more than 200 responses to the survey, which found the following key findings:
- Endocrinologists educate their patients on the signs and symptoms of hypoglycemia during most office visits and typically utilize a certified diabetes educator for supplemental diabetes training. However, no standard resource is used among those who responded to provide such education.
- Over the last 5-10 years, 75% of endocrinologists have changed their prescribing practices in patients with type 2 diabetes to select drugs with reduced hypoglycemic risk. Prescribing practices for patients with type 1 diabetes had also changed, though slightly less frequently than in the type 2 population.
- Approximately 90% of endocrinologists personalized A1C goals for their patients from those recommended in guidelines based on the frequency and/or severity of hypoglycemia that the patient had experienced.
- To address hypoglycemic unawareness, endocrinologists have referred patients to diabetes educators, increased A1C goals, prescribed CGM or pump therapy, changed insulin dosages, and recommended more frequent testing.
- While the vast majority of respondents use an EMR, it is not generally used to monitor data on hypoglycemia. Furthermore, such data is not generally automatically incorporated into the EMR.
- More than two-thirds of the respondents agreed that formulary or insurance approvals were contributing to economic burdens on the healthcare system.
Findings from the survey have demonstrated that hypoglycemia remains a key barrier to optimal patient outcomes and has contributed to changes in prescribing practices among the majority of endocrinologists. Many approaches are used to address hypoglycemia among patients with type 1 and type 2 diabetes. To better understand these barriers, the Society held a policy Summit, ACA Implementation: Impact on the Patient with Diabetes, to explore opportunities and challenges for improving diabetes care.
Drawing participants from numerous stakeholder groups, the Summit featured talks from key officials from the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the National Institute of Diabetes and Digestive and Kidney Diseases. Summit participants discussed policies that can positively impact the growing diabetes epidemic and identified key areas that require action. Following the Summit, the Society reconvened key diabetes stakeholders in attendance and held a hypoglycemia roundtable to delve deeper into these issues and to prioritize policies to address these barriers. The Society has developed a list of policy recommendations, as a result, which will be published in the March issue of The Journal of Clinical Endocrinology & Metabolism.
—Dyer is the Associate Director, Health Policy, Endocrine Society.