{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:22:29Z","timestamp":1792142549973,"version":"4.4.0"},"reference-count":32,"publisher":"American Diabetes Association","issue":"3","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["K23DK114497"],"award-info":[{"award-number":["K23DK114497"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>To characterize contemporary trends in glucagon fill rates and expenditures in a nationwide cohort of adults with diabetes overall and by key demographic and clinical characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESEARCH DESIGN AND METHODS<\/jats:title><jats:p>In this retrospective cohort study, we examined 1) glucagon fill rates per 1,000 person-years and 2) patient out-of-pocket and health plan costs per filled glucagon dose among adults with diabetes included in OptumLabs Data Warehouse between 1 January 2011 and 31 March 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The study population comprised 2,814,464 adults with diabetes with a mean age of 62.8 (SD 13.2) years. The overall glucagon fill rate decreased from 2.91 to 2.28 per 1,000 person-years (\u221222%) over the study period. In groups at high risk for severe hypoglycemia, glucagon fill rates increased from 22.46 to 36.76 per 1,000 person-years (64%) among patients with type 1 diabetes, 11.64 to 16.63 per 1,000 person-years (43%) among those treated with short-acting insulin, and 16.08 to 20.12 per 1,000 person-years (25%) among those with a history of severe hypoglycemia. White patients, women, individuals with high income, and commercially insured patients had higher glucagon fill rates compared with minority patients, males, individuals with low income, and Medicare Advantage patients, respectively. Total cost per dosing unit increased from $157.97 to $275.32 (74%) among commercial insurance beneficiaries and from $150.37 to $293.57 (95%) among Medicare Advantage beneficiaries.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Glucagon fill rates are concerningly low and declined between 2011 and 2021 but increased in appropriate subgroups with type 1 diabetes, using short-acting insulin, or with a history of severe hypoglycemia. Fill rates were disproportionately low among minority patients and individuals with low income.<\/jats:p><\/jats:sec>","DOI":"10.2337\/dc22-1564","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T18:52:34Z","timestamp":1673463154000},"page":"620-627","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":27,"title":["Glucagon Prescribing and Costs Among U.S. Adults With Diabetes, 2011\u20132021"],"prefix":"10.2337","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1592-0371","authenticated-orcid":false,"given":"Joseph R.","family":"Herges","sequence":"first","affiliation":[{"name":"1Pharmacy Services, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9295-3225","authenticated-orcid":false,"given":"Rodolfo J.","family":"Galindo","sequence":"additional","affiliation":[{"name":"2Division of Endocrinology and Metabolism, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4734-7402","authenticated-orcid":false,"given":"Joshua J.","family":"Neumiller","sequence":"additional","affiliation":[{"name":"3Department of Pharmacotherapy, Washington State University, Spokane, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert C.","family":"Heien","sequence":"additional","affiliation":[{"name":"4Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3252-5026","authenticated-orcid":false,"given":"Guillermo E.","family":"Umpierrez","sequence":"additional","affiliation":[{"name":"2Division of Endocrinology and Metabolism, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2289-3183","authenticated-orcid":false,"given":"Rozalina G.","family":"McCoy","sequence":"additional","affiliation":[{"name":"4Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN"},{"name":"5Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN"},{"name":"6OptumLabs, Eden Prairie, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2023,1,11]]},"reference":[{"key":"2023022220011828200_","unstructured":"Centers for Disease Control and Prevention . National Diabetes Statistics Report, 2020. Accessed 5 June 2022. Available from https:\/\/www.cdc.gov\/diabetes\/data\/statistics-report\/index.html"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"e000503","DOI":"10.1136\/bmjdrc-2017-000503","article-title":"Real-world crude incidence of hypoglycemia in adults with diabetes: results of the InHypo-DM Study, Canada","volume":"6","author":"Ratzki-Leewing","year":"2018","journal-title":"BMJ Open Diabetes Res Care"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"b4909","DOI":"10.1136\/bmj.b4909","article-title":"The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study","volume":"340","author":"Bonds","year":"2010","journal-title":"BMJ"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"316","DOI":"10.2337\/dc14-0920","article-title":"Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study","volume":"38","author":"Khunti","year":"2015","journal-title":"Diabetes Care"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.2337\/dc11-2054","article-title":"Increased mortality of patients with diabetes reporting severe hypoglycemia","volume":"35","author":"McCoy","year":"2012","journal-title":"Diabetes Care"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1056\/NEJMoa1003795","article-title":"Severe hypoglycemia and risks of vascular events and death","volume":"363","author":"Zoungas","year":"2010","journal-title":"N Engl J Med"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"792","DOI":"10.4158\/EP12382.OR","article-title":"Self-report of hypoglycemia and health-related quality of life in patients with type 1 and type 2 diabetes","volume":"19","author":"McCoy","year":"2013","journal-title":"Endocr Pract"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.jdiacomp.2012.05.002","article-title":"The burden of hypoglycemia on healthcare utilization, costs, and quality of life among type 2 diabetes mellitus patients","volume":"26","author":"Williams","year":"2012","journal-title":"J Diabetes Complications"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"420","DOI":"10.3111\/13696998.2015.1006730","article-title":"Economic impact of severe and non-severe hypoglycemia in patients with type 1 and type 2 diabetes in the United States","volume":"18","author":"Foos","year":"2015","journal-title":"J Med Econ"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.numecd.2016.01.007","article-title":"Costs associated with emergency care and hospitalization for severe hypoglycemia","volume":"26","author":"Veronese","year":"2016","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1001\/jamainternmed.2014.1824","article-title":"National trends in US hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999 to 2011","volume":"174","author":"Lipska","year":"2014","journal-title":"JAMA Intern Med"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"363","DOI":"10.2337\/dc15-0858","article-title":"Severe hypoglycemia requiring medical intervention in a large cohort of adults with diabetes receiving care in U.S. integrated health care delivery systems: 2005\u20132011","volume":"39","author":"Pathak","year":"2016","journal-title":"Diabetes Care"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s11606-017-4095-x","article-title":"Hospital readmissions among commercially insured and Medicare Advantage beneficiaries with diabetes and the impact of severe hypoglycemic and hyperglycemic events","volume":"32","author":"McCoy","year":"2017","journal-title":"J Gen Intern Med"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"e1919099","DOI":"10.1001\/jamanetworkopen.2019.19099","article-title":"Association of cumulative multimorbidity, glycemic control, and medication use with hypoglycemia-related emergency department visits and hospitalizations among adults with diabetes","volume":"3","author":"McCoy","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s11892-018-1018-0","article-title":"Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies","volume":"18","author":"Silbert","year":"2018","journal-title":"Curr Diab Rep"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"e1913249","DOI":"10.1001\/jamanetworkopen.2019.13249","article-title":"Racial and ethnic differences in 30-day hospital readmissions among US adults with diabetes","volume":"2","author":"Rodriguez-Gutierrez","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"S83","DOI":"10.2337\/dc22-S006","article-title":"6. Glycemic targets: Standards of Medical Care in Diabetes-2022","volume":"45","author":"Draznin","year":"2022","journal-title":"Diabetes Care"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"107882","DOI":"10.1016\/j.jdiacomp.2021.107882","article-title":"Glucagon use by U.S. adults with type 1 and type 2 diabetes","volume":"35","author":"Kahn","year":"2021","journal-title":"J Diabetes Complications"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"123","DOI":"10.4158\/EP15831.OR","article-title":"Glucagon prescription patterns in patients with either type 1 or 2 diabetes with newly prescribed insulin","volume":"22","author":"Mitchell","year":"2016","journal-title":"Endocr Pract"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s12020-018-1793-z","article-title":"The prescription rates of glucagon for hypoglycemia by pediatricians and physicians are low in Japan","volume":"64","author":"Matsumoto","year":"2019","journal-title":"Endocrine"},{"key":"2023022220011828200_","article-title":"Glucagon [package insert]","year":"1998"},{"key":"2023022220011828200_","article-title":"Gvoke PFS [package insert]","year":"2019"},{"key":"2023022220011828200_","article-title":"Baqsimi [package insert]","year":"2019"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1377\/hlthaff.2014.0038","article-title":"Optum Labs: building a novel node in the learning health care system [published correction appears in Health Aff (Millwood) 2014;33:1703]","volume":"33","author":"Wallace","year":"2014","journal-title":"Health Aff (Millwood)"},{"key":"2023022220011828200_","unstructured":"Department of Health and Human Services . Guidance regarding methods for de-identification of protected health information in accordance with the Health Insurance Portability and Accountability Act (HIPPA) privacy rule. Accessed 5 June 2022. Available from https:\/\/www.hhs.gov\/hipaa\/for-professionals\/privacy\/special-topics\/de-identification\/index.html#dates"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"key":"2023022220011828200_","first-page":"74","author":"National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) Comprehensive Diabetes Care","year":"2015"},{"key":"2023022220011828200_","unstructured":"Centers for Medicare & Medicaid Services . Limited income and resources. Accessed 5 June 2022. Available from https:\/\/www.cms.gov\/Medicare\/Prescription-Drug-Coverage\/LimitedIncomeandResources"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"2302","DOI":"10.2337\/dc20-2977","article-title":"Second-line therapy for type 2 diabetes management: the treatment\/benefit paradox of cardiovascular and kidney comorbidities","volume":"44","author":"McCoy","year":"2021","journal-title":"Diabetes Care"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"e2035792","DOI":"10.1001\/jamanetworkopen.2020.35792","article-title":"Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019","volume":"4","author":"McCoy","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2023022220011828200_","doi-asserted-by":"crossref","first-page":"427","DOI":"10.2337\/cd21-0004","article-title":"Easing the financial burden of diabetes management: a guide for patients and primary care clinicians","volume":"39","author":"Herges","year":"2021","journal-title":"Clin Diabetes"},{"key":"2023022220011828200_","unstructured":"UnitedHealth Group . UnitedHealthcare to eliminate out-of-pocket costs on several prescription drugs, including insulin, for eligible members. Accessed 25 July 2022. Available from https:\/\/www.unitedhealthgroup.com\/newsroom\/2022\/2022-07-15-uhg-eliminate-out-of-pocket-costs.html"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/46\/3\/620\/698561\/dc221564.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/46\/3\/620\/698561\/dc221564.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T18:46:54Z","timestamp":1679338014000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/46\/3\/620\/148260\/Glucagon-Prescribing-and-Costs-Among-U-S-Adults"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,11]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,1,11]]},"published-print":{"date-parts":[[2023,3,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc22-1564","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,11]]}}}