{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:16:15Z","timestamp":1788786975045,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Geriatrics Gerontology Int"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To assess prefecture\u2010level disparities in prehospital glucose administration for hypoglycemia among older adults, diabetologist density, and insulin prescribing, and to examine the association between diabetologist density and prehospital glucose administration in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a nationwide ecological cross\u2010sectional study across all 47 prefectures. Prehospital glucose administration for hypoglycemia was identified from national Emergency Medical Service statistics (2022). Diabetologist density (certified diabetologists per 100\u2009000 population) was obtained from the Japan Diabetes Society specialist list. Prescribing patterns were derived from the Musubi electronic medication history database (January 2019 to June 2025) and summarized as the proportion of insulin prescriptions among glucose\u2010lowering drugs. Pearson correlation coefficients were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Rates of prehospital glucose administration for hypoglycemia varied substantially across prefectures (approximately 10\u2010fold between the highest and lowest). Diabetologist density was inversely correlated with prehospital glucose administration per 100\u2009000 population (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.331,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05) and per 1000 EMS patients (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.425,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05); the inverse correlation per 1000 patients with diabetes was not statistically significant (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.274,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.062). Although diabetologist density was positively correlated with insulin prescribing proportion (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.326,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), it was inversely correlated with prehospital glucose administration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Marked geographic disparities in prehospital glucose administration for hypoglycemia were observed in Japan. Higher diabetologist density was associated with lower rates of prehospital glucose administration, despite a higher proportion of insulin prescribing, supporting efforts to improve access to certified diabetologists and strengthen diabetologist\u2013primary care collaboration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ggi.70639","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T12:25:09Z","timestamp":1783599909000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prefecture\u2010Level Prehospital Glucose Administration for Hypoglycemia and Diabetologist Density Among Older Adults in Japan: A Nationwide Ecological Study"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9690-3244","authenticated-orcid":false,"given":"Tomoya","family":"Saika","sequence":"first","affiliation":[{"name":"Patient Engagement Frontier Medical Science KAKEHASHI Inc.  Tokyo Japan"},{"name":"Graduate School of Medical and Pharmaceutical Sciences Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9511-0435","authenticated-orcid":false,"given":"Yuki","family":"Kado","sequence":"additional","affiliation":[{"name":"Patient Engagement Frontier Medical Science KAKEHASHI Inc.  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2866-9553","authenticated-orcid":false,"given":"Michiko","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Patient Engagement Frontier Medical Science KAKEHASHI Inc.  Tokyo Japan"},{"name":"Department of Hematology Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5945-5139","authenticated-orcid":false,"given":"Tohru","family":"Takebe","sequence":"additional","affiliation":[{"name":"Patient Engagement Frontier Medical Science KAKEHASHI Inc.  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7239-0988","authenticated-orcid":false,"given":"Masaya","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Metabolism &amp; Endocrinology International University of Health and Welfare Mita Hospital  Tokyo Japan"},{"name":"Department of Diabetes, Metabolism &amp; Endocrinology International University of Health and Welfare Narita Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3908-696X","authenticated-orcid":false,"given":"Atsushi","family":"Nakagomi","sequence":"additional","affiliation":[{"name":"Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f4533"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.571568"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.12587"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2019.107492"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc20\u20100316"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc\u20102014\u2010000063"},{"key":"e_1_2_13_8_1","volume-title":"Koreisha Tounyoubyou Shinryou Guideline 2023 [Elderly Diabetes Clinical Practice Guidelines 2023] (in Japanese)","author":"Japan Geriatrics Society, Japan Diabetes Society","year":"2023"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.14302"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1997.00440360095010"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.3961\/jpmph.21.215"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.05.029"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP.6.5.361"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP\u20102018\u20100405"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300\u2010020\u201000837\u20107"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.5334\/ijic.6025"},{"key":"e_1_2_13_17_1","unstructured":"Japan Diabetes Society \u201cCertified Diabetologists (Specialist Information) (in Japanese) \u201daccessed January 13 2026 https:\/\/www.jds.or.jp\/modules\/senmoni\/."},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1620\/tjem.251.1"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010018\u20103441\u2010y"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.33994"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/ams2.485"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2004.09.009"},{"key":"e_1_2_13_23_1","unstructured":"Ministry of Health Labour and Welfare (Japan) \u201cKyukyu kyumeishi\u2010ho shikou kisoku no ichibu o kaisei suru shorei tou no shikou ni tsuite [Implementation of ministerial ordinance revising enforcement regulations of the Emergency Life\u2010Saving Technicians Act] (in Japanese) \u201daccessed January 13 2026 https:\/\/www.mhlw.go.jp\/seisakunitsuite\/bunya\/kenkou_iryou\/iryou\/topics\/tp140204\u20101.html."},{"key":"e_1_2_13_24_1","unstructured":"Statistics Bureau of Japan \u201cNihon no Tokei 2025 (in Japanese) \u201daccessed January 13 2026 https:\/\/www.stat.go.jp\/data\/nihon\/index1.html."},{"key":"e_1_2_13_25_1","unstructured":"Ministry of Health Labour and Welfare (Japan) \u201cReiwa 5 nendo Kanja Chosa [Patient Survey 2023] (in Japanese) \u201daccessed January 13 2026 https:\/\/www.e\u2010stat.go.jp\/stat\u2010search\/files?page=1&query=%E7%B3%96%E5%B0%BF%E7%97%85&layout=dataset&toukei=00450022&tstat=000001224321&cycle=7&tclass1=000001224323&stat_infid=000040234513&tclass2val=0&metadata=1&data=1."},{"key":"e_1_2_13_26_1","unstructured":"Fire and Disaster Management Agency \u201cReiwa 6 nenban kyukyu kyuujo no genkyo: I Kyukyu hen [Current Status of Emergency and Rescue Services 2024: I Emergency Medical Services Section] (in Japanese) \u201daccessed May 21 2026 https:\/\/www.fdma.go.jp\/publication\/rescue\/post\u20106.html."},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.31662\/jmaj.2025\u20100152"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010025\u201012848\u2010w"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17176301"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.11240\/jsem.23.12"}],"container-title":["Geriatrics &amp; 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