First-ever quality measures aim to reduce diabetes complications

The Endocrine Society and Avalere Health introduced the first-ever quality measures to help healthcare providers assess how well they identify and care for older adults at greater risk of hypoglycemia—low blood sugar that can be a dangerous complication of diabetes treatment.

A panel of diabetes experts published the quality measures, which focus on outpatient treatment for adults who are 65 and older and have type 2 diabetes, in the Society’s Journal of Clinical Endocrinology & Metabolism. The panelists relied on their clinical background, measure development expertise, and insight into patient perspectives to develop the measure set.

“We convened an expert panel of endocrinologists, primary care physicians, diabetes educators, pharmacists, measurement experts and patient advocates to ensure that the quality measures reflect a variety of perspectives and a wide breadth of knowledge on hypoglycemia prevention,” said James L. Rosenzweig, MD, of Hebrew SeniorLife in Boston, Mass., who led the expert panel.

An estimated 33 percent of adults aged 65 or older have diabetes, and this age group faces increased risk of developing hypoglycemia. Hypoglycemia can lead to seizures, coma and even death. The U.S. Department of Health and Human Services identified hypoglycemia as one of the top three preventable and measurable adverse drug events.

“Hypoglycemia is an area where we can make meaningful strides in improving diabetes care,” said Rosenzweig. “Our research has shown a lack of widespread initiatives to address this issue. These first-of-their-kind quality measures will help clinicians better identify patients who are at risk and combat hypoglycemia.”

“Avalere is excited to have been involved in the development of measures focused on older adults who are at risk of having hypoglycemia,” said Kristi Mitchell, Practice Director at Avalere Health. “To date, there has been a gap in outpatient measures that screens patients for risk of hypoglycemia and setting tailored targets for this population. We look forward to continuing our work with the Hypoglycemia Prevention Initiative to address this need.”

The quality measures outline key risk factors that raise an individual’s chances of developing hypoglycemia and emphasize the importance of people who meet these criteria receiving education to help prevent future episodes.

Key risk factors include:

• Experiencing a hypoglycemic event where blood glucose levels dropped below 54 mg/dL and required immediate attention within the past year
• Experiencing altered mental or physical status requiring assistance during a severe hypoglycemic event in the past year

Among individuals who manage their blood sugar with insulin or medicines like sulfonylureas that increase the risk of hypoglycemia:

• A documented A1c of less than 7 percent in the past six months, or
• At least one other relevant chronic medical problem.

The expert panel also recommends healthcare providers capture information about hypoglycemic episodes where individuals experienced altered mental or physical status requiring assistance within the past year. This information can help clinicians better determine if an individual is experiencing growing unawareness of hypoglycemia over time and identify what kinds of interventions stand the best chance of helping the patient avoid future episodes.

Once medical centers and practices begin using the quality measures, the Society and Avalere hope to use information and data from users to refine the quality measures in the future.

Other authors of the report and recommendations include: Paul R. Conlin, MD, of VA Boston Healthcare System in Boston, Mass.; Jasmine D. Gozalvo, PharmD, BCPS, BC-ADM, CDE, LDE, FAADE, of Purdue University in West Lafayette, Ind.; Stephanie B. Kutler, Endocrine Society; Nisa Maruthur, MD, MHS, of Johns Hopkins University in Baltimore, Md.; Penelope Soli, JD, Avalere Health in Washington, D.C.; Sandeep Vijan, MD, of the University of Michigan in Ann Arbor, Mich.; Amish Wallia, MD, of Northwestern University in Chicago, Ill.; and Robin Fein Wright, LCSW, of Diabetes Sisters in Bolingbrook, Ill.

The work on measures was part of a broader quality improvement effort, the Hypoglycemia Prevention Initiative, which was launched by the Endocrine Society and Avalere Health to study how hypoglycemia could be prevented in older individuals with type 2 diabetes and whether primary care physicians could incorporate diagnostic and preventive services into their workflow. The Hypoglycemia Prevention Initiative is supported by Merck & Co., Inc.; Lilly USA, LLC; Novo Nordisk Inc.; Sanofi; and Abbott Diabetes Care Inc.

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