Rochester, MN—The American Diabetes Association recommends that diabetes patients using insulin or sulfonylurea to manage their diabetes keep a glucagon kit with them in case of an emergency.

Glucagon, which can be administered as a spray or SC injection, is used to treat severe hypoglycemia. However, if the experience of a large integrated healthcare system is any indication, the overwhelming majority of patients who might need glucagon have not been prescribed it.

A new study from the Mayo Clinic examined glucagon prescribing trends among patients at high risk of severe hypoglycemia. The researchers also assessed whether a glucagon prescription is associated with lower rates of severe hypoglycemia requiring hospital care.

The results were published in Diabetes Research and Clinical Practice.

To do that, the study team conducted a retrospective analysis of electronic health records from a large integrated healthcare system between May 2019 and August 2021. The study included adults with type 1 diabetes or with type 2 diabetes treated with short-acting insulin and/or recent history of hypoglycemia-related emergency department visits or hospitalization.

The researchers first calculated rates of glucagon prescribing overall and by patient characteristics. Then, they matched 1:1 those who had been prescribed glucagon and those who had not, assessing subsequent hypoglycemia-related hospitalization.

The results indicated that of the 9,200 high-risk adults, 2,063 (22.4%) were prescribed glucagon. More likely to be prescribed glucagon were those who were younger, female, white, living in urban areas, with prior severe hypoglycemia, and with a recent endocrinology specialist visit.

In the matched cohort, which involved 1,707 adults per arm, 62 patients prescribed glucagon and 33 not prescribed glucagon were hospitalized for hypoglycemia (adjusted incidence rate ratio 1.71; 95% CI, 1.10-2.66; P = .018).

“Glucagon prescribing was infrequent with significant racial and rural disparities,” the researchers concluded. “Patients with glucagon prescriptions did not have lower rates of hospitalization for hypoglycemia.”

In 2019, the FDA approved Baqsimi nasal powder, the first glucagon therapy approved for the emergency treatment of severe hypoglycemia that can be administered without an injection. In 2020, it approved the first generic of glucagon for injection USP, 1-mg/vial packaged in an emergency kit, for the treatment of severe hypoglycemia.

Glucagon is a hormone that causes the liver to quickly increase blood sugar levels, according to the FDA, and also slows down movement of the gastrointestinal tract. The most common side effects associated with glucagon for injection are nausea and vomiting, a temporary increase in heart rate, as well as redness and swelling of the injection site.

A study late last year in the Journal of Clinical & Translational Endocrinology reported on the results of focus groups with participants diagnosed with type 1 diabetes. “Participants frequently identified prescription cost and insurance deductibles as barriers to glucagon use,” wrote the authors from Ohio University Heritage College of Osteopathic Medicine and colleagues. “Participants were also concerned about ease of administration—how difficult it is to prepare the glucagon in an emergency. Many participants expressed a preference for auto-injectables over nasal administration.”

The researchers also found that the timing of glucagon action and time to recovery were high priorities. They also were looking for reduced cost, long shelf-life, and quick activation.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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