2025 Southeastern Residency Conference

Title: Implementation of a Glucagon Discharge Prescription Protocol at a Large Community Hospital


Authors: Grace Rooks, Sophia Carter, Lauren Butler, Anna Cross


Background: According to the American Diabetes Association (ADA) and the Endocrine Society, patients at risk for emergent hypoglycemia, including those treated with insulin, should have access to glucagon to help prevent prolonged severe hypoglycemia and its complications. Severe hypoglycemia is a frequent cause of expensive emergency department visits and the use of emergency medical services. Hypoglycemia events result in more than 100,000 emergency department visits annually, with a cost of roughly $120 million. Clinicians should readily assess patients’ access to glucagon, and the ADA guidelines recognize that glucagon prescribing practices are very low. The purpose of this project is to increase at home access to glucagon for emergent hypoglycemia events in at risk patients. 


Methods: This is a single-center analysis of pre-implementation data from May to August 2024 and post-implementation data from November 2024 to February 2025. Patients included in this study were 19 years of age or older who have been diagnosed with Type 1 or Type 2 Diabetes or Latent autoimmune diabetes in adults (LADA). Due to the majority of insulin prescribers at Huntsville Hospital being the hospitalists, endocrinologists, University of Alabama at Birmingham (UAB) physicians, a glucagon discharge prescription protocol was created by clinical pharmacists and approved by these providers for insulin prescriptions sent to Huntsville Hospital retail pharmacies. The protocol allows transitions of care (TOC) pharmacists to add glucagon for patients with a new insulin prescription at discharge who did not already have a glucagon prescription. The primary endpoint of this study is the number of glucagon prescriptions that were dispensed for adult patients who received a new insulin prescription at discharge. Additionally, rates of glucagon initiation, initiating service, different dispensing barriers, and cost margins will be evaluated.  


Results: In the pre-implementation group, 2 glucagon prescriptions were sent and 1 was dispensed. In the post-implementation group, 35 glucagon prescriptions were sent and 17 (49%) were dispensed. 94% of glucagon prescriptions from the post-implementation group were sent by a TOC pharmacist. Of the 18 glucagon prescriptions that were not dispensed, majority of them were due to the patient requesting a prescription transfer (77.7%). Of the 25 uninsured patients, 12 (48%) received a patient assistance pamphlet.


Conclusion: The implementation of a glucagon discharge prescription protocol increased patient access to glucagon at home for the treatment of emergent hypoglycemia and increased glucagon prescribing rates. Patients’ pharmacy preference had the largest impact on glucagon dispensing rates. Pertinent limitations include sending prescriptions to only Huntsville Hospital retail pharmacies and excluding patients that are discharged outside of TOC pharmacist coverage areas and hours. Educating and involving more providers is needed to increase glucagon access at home in addition to continued protocol practices.