American Diabetes Association
Glucagon_fills_diabetes_care_supplement_revision_clean.pdf (126.73 kB)

Glucagon Prescribing and Costs Among U.S. Adults with Diabetes, 2011-2021

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posted on 2023-01-11, 18:49 authored by Joseph R. Herges, Rodolfo J. Galindo, Joshua J. Neumiller, Herbert C. Heien, Guillermo E. Umpierrez, Rozalina G. McCoy


OBJECTIVE: 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.

RESEARCH DESIGN AND METHODS: In this retrospective cohort study, we examined 1) glucagon fill rates per 1000 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 January 1st, 2011, and March 31st, 2021.

RESULTS: The study population was comprised of 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 1000 person-years (-22%) over the study period. Glucagon fill rates increased in groups at high risk for severe hypoglycemia; from 22.46 to 36.76 (+64%), from 11.64 to 16.63 (+43%) and 16.08 to 20.12 (+25%) among patients with type 1 diabetes, patients treated with short-acting insulin and those with history of severe hypoglycemia, respectively. White patients, women, higher income individuals, and commercially-insured patients had higher glucagon fill rates when compared to minorities, males, lower income individuals, and Medicare Advantage patients, respectively. Total cost per dosing unit increased from $157.97 to $275.32 (+74%) among commercial beneficiaries and from $150.37 to $293.57 (+95%) among Medicare Advantage beneficiaries. 

CONCLUSIONS: Glucagon fill rates are concerningly low and declined between 2011 and 2021, though increased in appropriate subgroups with type 1 diabetes, using short-acting insulin, or a history of severe hypoglycemia. Fill rates were disproportionately low among minorities and low-income individuals. 


This work was funded by the National Institute of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant number K23DK114497 and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.


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