Acceptability and Feasibility of a Primary Care Hypoglycemia Prevention Program: A Pilot Study

Abstract

OBJECTIVE Hypoglycemia, a major cause of morbidity for people with diabetes, is underrecognized in primary care, leading to underuse of risk mitigation strategies. This study reports the development and acceptability/feasibility testing of the Hypoglycemia Prevention Program (HPP), an electronic health record–integrated toolkit for primary care. RESEARCH DESIGN AND METHODS The HPP was developed through stakeholder engagement and included a pre-visit hypoglycemia history survey, primary care provider (PCP) hypoglycemia toolkit, and patient self-management handout. The HPP pilot study was a pre-post clinical trial at one primary care practice. Participants were adults with diabetes treated with insulin or sulfonylureas, their PCPs, and clinic staff. The primary outcome was acceptability; exploratory outcomes included pre- to postintervention change in PCP hypoglycemia prevention actions, self-reported hypoglycemia, and optional blinded 10-day continuous glucose monitoring (CGM). RESULTS The intervention was completed by 31 of 35 enrolled patients with diabetes (89%) for whom it triggered frequent hypoglycemia alerts. The intervention was rated acceptable or completely acceptable by 87% of patients and 100% of participating PCPs (n = 12) and clinic staff (n = 5). PCPs increased indicated glucagon prescribing from pre- to postintervention (0% preintervention to 32% postintervention, P = 0.003); there were small increases in CGM initiation and deintensification of hypoglycemia-causing medications. Self-reported and CGM-detected hypoglycemia decreased from pre- to postintervention, although with incomplete ascertainment and low CGM participation (n = 11). CONCLUSIONS A hypoglycemia prevention program designed for primary care is feasible to implement and acceptable to clinical and patient stakeholders, with evidence of improved hypoglycemia prevention efforts. Further efficacy evaluation is needed.