Language
English
Publication Date
12-1-2023
Journal
The Lancet Regional Health – Americas
DOI
10.1016/j.lana.2023.100641
PMID
38076413
PMCID
PMC10701452
PubMedCentral® Posted Date
11-24-2023
PubMedCentral® Full Text Version
Post-Print
Abstract
BACKGROUND: Hypoglycaemia from diabetes treatment causes morbidity and lower quality of life, and prevention should be routinely addressed in clinical visits.
METHODS: This mixed methods study evaluated how primary care providers (PCPs) assess for and prevent hypoglycaemia by analyzing audio-recorded visits from five Veterans Affairs medical centres in the US. Two investigators independently coded visit dialogue to classify discussions of hypoglycaemia history, anticipatory guidance, and adjustments to hypoglycaemia-causing medications according to diabetes guidelines.
FINDINGS: There were 242 patients (one PCP visit per patient) and 49 PCPs. Two thirds of patients were treated with insulin and 40% with sulfonylureas. Hypoglycaemia history was discussed in 78/242 visits (32%). PCPs provided hypoglycaemia anticipatory guidance in 50 visits (21%) that focused on holding diabetes medications while fasting and carrying glucose tabs; avoiding driving and glucagon were not discussed. Hypoglycaemia-causing medications were de-intensified or adjusted more often (p < 0.001) when the patient reported a history of hypoglycaemia (15/51 visits, 29%) than when the patient reported no hypoglycaemia or it was not discussed (6/191 visits, 3%). Haemoglobin A1c (HbA1c) was not associated with diabetes medication adjustment, and only 5/12 patients (42%) who reported hypoglycaemia with HbA1c
INTERPRETATION: PCPs discussed hypoglycaemia in one-third of visits for at-risk patients and provided limited hypoglycaemia anticipatory guidance. De-intensifying or adjusting hypoglycaemia-causing medications did not occur routinely after reported hypoglycaemia with HbA1c
FUNDING: U.S. Department of Veterans Affairs and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Keywords
Diabetes mellitus, Hypoglycemia, Drug-related side effects and adverse reactions, Deprescriptions, Health education
Published Open-Access
yes
Recommended Citation
Pilla, Scott J; Meza, Kayla A; Beach, Mary Catherine; et al., "Assessment and Prevention of Hypoglycaemia in Primary Care Among US Veterans: A Mixed Methods Study" (2023). Faculty and Staff Publications. 1520.
https://digitalcommons.library.tmc.edu/baylor_docs/1520
Included in
Biochemical Phenomena, Metabolism, and Nutrition Commons, Endocrine System Diseases Commons, Endocrinology, Diabetes, and Metabolism Commons, Internal Medicine Commons