Abstract
Background
The American Diabetes Association (ADA) recommends prescribing glucagon for people with diabetes (PWD) using insulin or at high risk of hypoglycemia; however, prescribing rates remain low. Few studies have examined practices and barriers to outpatient glucagon use from pharmacists' perspectives.Objective
This study aimed to describe pharmacists' perspectives on current practices and barriers to outpatient glucagon use in PWD.Methods
A voluntary, electronic survey questionnaire was distributed to 1,624 members of the American College of Clinical Pharmacy Ambulatory Care and Endocrine and Metabolism Practice and Research Networks. Categorical, Likert, and open-ended questions were used to evaluate practice scope, patient population, and knowledge and perceptions related to glucagon use. Statistical analyses were conducted using IBM SPSS Statistics and the Stats iQ function within the Qualtrics® platform.Results
Of the 186 respondents included, most pharmacists practiced in urban areas (58.2%) and primary care (83.1%), with a mean of 10.6 years of experience managing PWD. Respondents estimated that 23.5% of their patients with diabetes have an active glucagon prescription, and 42.1% fill their prescription. In hypothetical patients, respondents were most likely to recommend or prescribe glucagon for PWD with a history of hypoglycemia requiring medical attention (95.7%), recurrent hypoglycemia (89.6%), or using intensive insulin regimens, including continuous subcutaneous insulin infusion (82.3-93.9%). Respondents were less likely to do so for people with type 2 diabetes using basal insulin only (38.4%) or secretagogues (17.1%), or PWD with a history of an isolated hypoglycemic event (17.7%). The most frequently identified barriers to outpatient glucagon use were cost (75.5%), patient health literacy regarding when to use glucagon (71.7%), and insurance coverage (68.2%).Conclusion
Current practices among pharmacists engaged in outpatient diabetes management may not fully align with recommendations for glucagon use, highlighting opportunities for pharmacists to support strategies that optimize appropriate glucagon prescribing for high-risk patients.