Glucagon use declines from 2011 to 2021 among adults with diabetes
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Fewer people with diabetes filled glucagon prescriptions in 2021 compared with 2011, though increases were seen among those with type 1 diabetes and adults with a history of severe hypoglycemia, according to study data.
“Glucagon, which can be potentially life-saving, remains extremely underutilized, and this is despite it being easier to administer glucagon products coming to market,” Joseph Herges, PharmD, outpatient and medication therapy management clinical pharmacist in family medicine at Mayo Clinic in Rochester, Minnesota, told Healio. “The findings show that there is much work to be done to improve access to glucagon for high-risk patients with diabetes. The solutions are multifactorial and include addressing barriers to access, like high medication cost, and developing innovative tools, like real-time alerts, to increase prescribing.”
Herges and colleagues conducted a retrospective analysis of claims data from the OptumLabs Data Warehouse. Adults aged 18 years and older with type 1 or type 2 diabetes and 12 months of uninterrupted medical or pharmacy coverage were included. Pharmacy claims were collected to identify glucagon fills for each calendar quarter that medical and pharmacy insurance coverage was available. Data were collected from January 2011 to March 2021.
There were 2,814,464 adults included in the study (mean age, 62.8 years; 50.1% women). Of the cohort, 1.5% filled at least one glucagon prescription. There were 308,281 adults using short-acting insulin at baseline, of whom 8.7% filled a glucagon prescription at least once. Glucagon fill rates were lower for those using only long-acting insulin at baseline (2.3%) and those who did not use insulin (0.4%).
Glucagon fill rates declined by 22% from 2.91 per 1,000 person-years in the first quarter of 2011 to 2.28 per 1,000 person-years in the first quarter of 2021. Adults with Medicare Advantage had a 39% decrease in glucagon fill rates from 2011 to 2021, whereas fill rates increased by 19% among those with commercial insurance. Lyophilized glucagon kits were the most common type of glucagon fills at the end of the study, though the use of intranasal glucagon and other newer formulations began increasing in the first quarter of 2020.
Glucagon fill rates increased among some subgroups. From the first quarter of 2011 to the first quarter of 2021, adults with a history of hospitalization for severe hypoglycemia had a 25% increase in fill rates, and adults with type 1 diabetes had a 64% increase in fill rates. Those using short-acting insulin at baseline had a 43% increase in glucagon use, prescription fills increased 96% among those using long-acting insulin, and glucagon fills increased by 34% among people without insulin fills at baseline.
“While all three of these treatment groups had increased glucagon fills over time, we saw an overall reduction in glucagon fills due to increasing numbers of patients not treated with insulin whose glucagon fill rates were lowest,” the researchers wrote.
Glucagon fill rates were highest among white adults and lowest among Asian adults in an analysis of racial-ethnic groups. Glucagon fill rates progressively decreased as annual household income decreased.
From the first quarter of 2011 to the first quarter of 2021, glucagon costs increased by 95% for Medicare Advantage beneficiaries and by 74% for adults with commercial insurance. Patient out-of-pocket costs increased by 76% for those with Medicare Advantage and 56% among commercial insurance beneficiaries.
“We need research to better understand what drives low prescribing rates and what prevents glucagon fills in the real world for patients who should have access,” Herges said. “It would also be valuable to explore if glucagon prescriptions or fills translate to reduced emergency department visits and hospitalizations for severe hypoglycemia.”
For more information:
Joseph Herges, PharmD, can be reached at joseph@mayo.edu.
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