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Endocrine

pp 1–9 | Cite as

Documentation of hypoglycemia assessment among adults with diabetes during clinical encounters in primary care and endocrinology practices

  • Rene Rodriguez-Gutierrez
  • Alejandro Salcido-Montenegro
  • Naykky M. Singh-Ospina
  • Spyridoula Maraka
  • Nicole Iñiguez-Ariza
  • Gabriela Spencer-Bonilla
  • Shrikant U. Tamhane
  • Kasia J. Lipska
  • Victor M. Montori
  • Rozalina G. McCoyEmail author
  • on behalf of the Hypoglycemia as a Quality Measure in Diabetes Study Group
Original Article

Abstract

Purpose

To examine the proportion of diabetes-focused clinical encounters in primary care and endocrinology practices where the evaluation for hypoglycemia is documented; and when it is, identify clinicians’ stated actions in response to patient-reported events.

Methods

A total of 470 diabetes-focused encounters among 283 patients nonpregnant adults (≥18 years) with type 1 or type 2 diabetes mellitus in this retrospective cohort study. Participants were randomly identified in blocks of treatment strategy and care location (95 and 52 primary care encounters among hypoglycemia-prone medications (i.e. insulin, sulfonylurea) and others patients, respectively; 94 and 42 endocrinology encounters among hypo-treated and others, respectively). Documentation of hypoglycemia and subsequent management plan in the electronic health record were evaluated.

Results

Overall, 132 (46.6%) patients had documentation of hypoglycemia assessment, significantly more prevalent among hypo-treated patients seen in endocrinology than in primary care (72.3% vs. 47.4%; P = 0.001). Hypoglycemia was identified by patient in 38.2% of encounters. Odds of hypoglycemia assessment documentation was highest among the hypo-treated (OR 13.6; 95% CI 5.5−33.74, vs. others) and patients seen in endocrine clinic (OR 4.48; 95% CI 2.3−8.6, vs. primary care). After documentation of hypoglycemia, treatment was modified in 30% primary care and 46% endocrine clinic encounters; P = 0.31. Few patients were referred to diabetes self-management education and support (DSMES).

Conclusions

Continued efforts to improve hypoglycemia evaluation, documentation, and management are needed, particularly in primary care. This includes not only screening at-risk patients for hypoglycemia, but also modifying their treatment regimens and/or leveraging DSMES.

Keywords

Hypoglycemia Type 2 diabetes Type 1 diabetes Primary care Healthcare quality Endocrinology 

Notes

Acknowledgements

We thank Darrell Schroeder from the Mayo Clinic Department of Medicine Clinical Research Office and Division of Biostatistics, who was instrumental in identifying patients meeting inclusion criteria for the study and randomly selecting participants for each cohort.

Author contributions

R.R.-G., V.M.M. and R.G.M. analyzed the data, designed the research and wrote the manuscript. R.R.-G., A.S.-M., N.M.S.-O., S.M., N.I.-A., G.S.-B., S.U.T., K.J.L., performed the research and analyzed the data and reviewed the manuscript. R.R.-G. and R.G.M. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. R.G.M. is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number K23DK114497. S.M. receives support by the Arkansas Biosciences Institute, the major research component of the Arkansas Tobacco Settlement Proceeds Act of 2000. K.J.L. receives support from the National Institute on Aging and the American Federation of Aging Research through the Paul Beeson Career Development Award (K23AG048359) and from CMS to develop and maintain publicly reported quality measures. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Mayo Clinic Institutional Review Board (reference number 10429) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Rene Rodriguez-Gutierrez
    • 1
    • 2
    • 3
    • 4
  • Alejandro Salcido-Montenegro
    • 3
    • 4
  • Naykky M. Singh-Ospina
    • 1
    • 5
  • Spyridoula Maraka
    • 1
    • 6
  • Nicole Iñiguez-Ariza
    • 2
    • 7
  • Gabriela Spencer-Bonilla
    • 1
    • 8
  • Shrikant U. Tamhane
    • 2
  • Kasia J. Lipska
    • 9
  • Victor M. Montori
    • 1
    • 2
  • Rozalina G. McCoy
    • 10
    • 11
    • 12
    Email author
  • on behalf of the Hypoglycemia as a Quality Measure in Diabetes Study Group
  1. 1.Knowledge and Evaluation Research Unit in EndocrinologyMayo ClinicRochesterUSA
  2. 2.Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of MedicineMayo ClinicRochesterUSA
  3. 3.Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. JoséE. González”Universidad Autonoma de Nuevo LeonMonterreyMéxico
  4. 4.Plataforma INVEST Medicina UANL—KER Unit (KER Unit México), Subdirección de InvestigaciónUniversidad Autónoma de Nuevo LeónMonterreyMéxico
  5. 5.Division of Endocrinology, Department of MedicineUniversity of FloridaGainesvilleUSA
  6. 6.Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone DiseasesUniversity of Arkansas for Medical Sciences and the Central Arkansas Veterans Health Care SystemLittle RockUSA
  7. 7.Department of Endocrinology and MetabolismInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
  8. 8.Department of MedicineStanford University School of MedicineStanfordUSA
  9. 9.Section of Endocrinology, Department of Internal MedicineYale School of MedicineNew HavenUSA
  10. 10.Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterUSA
  11. 11.Division of Community Internal Medicine, Department of MedicineMayo ClinicRochesterUSA
  12. 12.Division of Health Care Policy & Research, Department of Health Sciences ResearchMayo ClinicRochesterUSA

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