The Hypoglycemia Prevention Initiative is a multi-year joint effort of the Endocrine Society and Avalere Health to determine best practices in primary care to reduce the impact of hypoglycemia on older (65+) people with type 2 diabetes (T2D) who use insulin and/or sulfonylurea, have a recent A1c <7%, and are at increased risk of hypoglycemia. The initial effort of this initiative is the Hypoglycemia Prevention Study (HypoPrevent), an implementation research and quality improvement (QI) study designed to test an intervention in primary care settings to identify older people with T2D at risk of hypoglycemia and a clinical decision support tool designed to facilitate risk reduction.
Why Focus on Hypoglycemia?
Identified as one of the top three preventable adverse drug reactions by the US Department of Health and Human Services
Average incidence of hypoglycemia among people with T2D on insulin is 23 mild or moderate events and 1 severe episode per year
Between January 2007 and December 2011, emergency department visits for therapy-associated hypoglycemia among Medicare beneficiaries resulted in more than $600 million in spending
Among Medicare-aged individuals, hospitalization for hypoglycemia is associated with a 30-day readmission rate of 18.1%
Mild or moderate hypoglycemia can significantly affect a person’s quality of life, social life, work productivity, and ability to drive safely
Primary care clinicians provide the majority of care for people with T2D
This study assesses various methods to decrease the risk of hypoglycemia on an individual basis through shared decision making (SDM), individualized A1c goals and/or changes to their glucose-lowering medications regimen. The diabetes educator, who is also the practice coordinator for this study, plays a key role with annual assessments and education on glucose-lowering medications and their mechanism of action.
1: Increasing outpatient hypoglycemia surveillance & risk assessment by integrating a risk assessment into primary care clinical workflow
2: Improving the management of older type 2 diabetes patients on insulin and sulfonylureas
3: Developing outpatient hypoglycemia quality measures and integrating them into primary care practices to incentivize high-quality care
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.