Since 2014, the Endocrine Society has made hypoglycemia a strategic priority, conducting a series of roundtables with key stakeholders from the federal government, provider community, patient advocates, and payers to determine a comprehensive approach to this problem. We have now embarked on a multi-year quality improvement project, the Hypoglycemia Prevention Initiative, to design and test clinical interventions in primary care settings that will aim to decrease the number of patients at high-risk and the frequency and severity of their episodes. The initiatives' goals include:

  • Decreasing population of patients with T2D on insulin and/or SUs who are high risk for hypoglycemia as an ADE
  • Decreasing the frequency and severity of hypoglycemia as an ADE among patients with T2D on insulin and/or SUs who are identified as high risk

Objectives & Tactics

Increase Outpatient Hypoglycemia Surveillance & Risk Assessment

  • Integrate risk assessment into clinical workflow in primary care

Improve Management of Patients on Insulin and Sulfonylureas

  • Share best practices with primary care on how to prevent hypoglycemia, and individualize goals and adjust medication regimens as part of managing high-risk patients
  • Provide educational tools to help patients identify and manage hypoglycemia

Align Provider Reimbursement to Promote Best Practices

  • Develop quality measures for eventual use in value-based reimbursement programs to recognize high-quality care
  • Potential opportunity to achieve MIPS Improvement Activities reporting requirements through the provision of glycemic management services

Potential Impact of the Hypoglycemia Prevention Initiative on Stakeholders

Hypoglycemia can significantly affect a person’s quality of life, social life, work productivity, and ability to drive safely. In more serious cases, it can result in patient ED visits and hospitalizations.

To support patients in expressing their personal preferences in the course of treatment and being better able to identify early signs hypoglycemia, the Initiative will provide them with educational resources and meaningful office interactions with PCPs.

Currently, PCPs’ clinical workflows do not support routine identificationand monitoring patients at high risk for hypoglycemia.

The Initiative will provide PCPs with:

1. much needed risk assessment and clinical decision support tools to identify patients at high risk earlier on and improve their management through individualization of glycemic targets, and

2. tools that they can give to their patients to help them with self-management.

Given endocrinologists’ focus on treating the most complex patients with Type 2 Diabetes, this Initiative provides these specialists the opportunity to collaborate with PCPs and other providers to improve hypoglycemia prevention in primary care.

Tools and resources that will be developed as part of the Initiative will ultimately advance care coordination between primary care and endocrinology practices, and ensure the right patients are treated in the right setting at the right time.

When patients at high risk for hypoglycemia do not receive appropriate treatment (based on individualized glycemic targets), they are at higher risk of discontinuing their anti-hyperglycemic treatment, as well as not being as able to comply with the treatment of comorbidities.

The Initiative’s interventions will aim to ensure optimal efficacy and safety of medications used and empower patients to have a voice in treatment decisions to manage their condition(s).

Between January 2007 and December 2011, ED visits for therapy-associated hypoglycemia resulted in spending of more than $600 million.

The Initiative will aim to improve health outcomes, including decreasing the frequency and severity of hypoglycemia, by improving the identification and management of patients at high-risk of the condition.

It is also hoped that in the long term, increased surveillance of high-risk patients with adequate follow-up can result inthe reduction of avoidable ED visits and hospitalizations.



Steering Committee

Jeffrey Boord

Dr. Jeffrey Boord
Steering Committee Chair
Parkview Health

Jesse Bushman

Jesse Bushman
Senior Director, Health Policy

Lawrence Dardick

Dr. Lawrence Dardick
UCLA Medical Center
Family Medicine


Dr. Kathleen Dungan
Ohio State University Wexner Medical Center

Deborah Koehn

Dr. Deborah Koehn
Virginia Commonwealth University Medical Center
Internal Medicine

Ken Snow

Dr. Ken Snow
Medical Director

Amisha Wallia

Dr. Amisha Wallia
Northwestern Memorial Hospital

Hope Warshaw

Hope Warshaw, RD, CDE, BC-ADM
Hope Warshaw Associates, LLC
Dietician and Diabetes Educator



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