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Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes.

Publication ,  Journal Article
Pilla, SJ; Park, J; Schwartz, JL; Albert, MC; Ephraim, PL; Boulware, LE; Mathioudakis, NN; Maruthur, NM; Beach, MC; Greer, RC
Published in: J Gen Intern Med
June 2021

BACKGROUND: Hypoglycemia is a common and serious adverse effect of diabetes treatment, especially for patients using insulin or insulin secretagogues. Guidelines recommend that these patients be assessed for interval hypoglycemic events at each clinical encounter and be provided anticipatory guidance for hypoglycemia prevention. OBJECTIVE: To determine the frequency and content of hypoglycemia communication in primary care visits. DESIGN: Qualitative study PARTICIPANTS: We examined 83 primary care visits from one urban health practice representing 8 clinicians and 33 patients using insulin or insulin secretagogues. APPROACH: Using a directed content analysis approach, we analyzed audio-recorded primary care visits collected as part of the Achieving Blood Pressure Control Together study, a randomized trial of behavioral interventions for hypertension. The coding framework included communication about interval hypoglycemia, defined as discussion of hypoglycemic events or symptoms; the components of hypoglycemia anticipatory guidance in diabetes guidelines; and hypoglycemia unawareness. Hypoglycemia documentation in visit notes was compared to visit transcripts. KEY RESULTS: Communication about interval hypoglycemia occurred in 24% of visits, and hypoglycemic events were reported in 16%. Despite patients voicing fear of hypoglycemia, clinicians rarely assessed hypoglycemia frequency, severity, or its impact on quality of life. Hypoglycemia anticipatory guidance was provided in 21% of visits which focused on diet and behavior change; clinicians rarely counseled on hypoglycemia treatment or avoidance of driving. Limited discussions of hypoglycemia unawareness occurred in 8% of visits. Documentation in visit notes had low sensitivity but high specificity for ascertaining interval hypoglycemia communication or hypoglycemic events, compared to visit transcripts. CONCLUSIONS: In this high hypoglycemia risk population, communication about interval hypoglycemia and counseling for hypoglycemia prevention occurred in a minority of visits. There is a need to support clinicians to more regularly assess their patients' hypoglycemia burden and enhance counseling practices in order to optimize hypoglycemia prevention in primary care.

Duke Scholars

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

June 2021

Volume

36

Issue

6

Start / End Page

1533 / 1542

Location

United States

Related Subject Headings

  • Quality of Life
  • Primary Health Care
  • Insulin
  • Hypoglycemic Agents
  • Hypoglycemia
  • Humans
  • General & Internal Medicine
  • Diabetes Mellitus, Type 2
  • Diabetes Mellitus
  • Communication
 

Citation

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Chicago
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Pilla, S. J., Park, J., Schwartz, J. L., Albert, M. C., Ephraim, P. L., Boulware, L. E., … Greer, R. C. (2021). Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes. J Gen Intern Med, 36(6), 1533–1542. https://doi.org/10.1007/s11606-020-06385-x
Pilla, Scott J., Jenny Park, Jessica L. Schwartz, Michael C. Albert, Patti L. Ephraim, L Ebony Boulware, Nestoras N. Mathioudakis, Nisa M. Maruthur, Mary Catherine Beach, and Raquel C. Greer. “Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes.J Gen Intern Med 36, no. 6 (June 2021): 1533–42. https://doi.org/10.1007/s11606-020-06385-x.
Pilla SJ, Park J, Schwartz JL, Albert MC, Ephraim PL, Boulware LE, et al. Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes. J Gen Intern Med. 2021 Jun;36(6):1533–42.
Pilla, Scott J., et al. “Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes.J Gen Intern Med, vol. 36, no. 6, June 2021, pp. 1533–42. Pubmed, doi:10.1007/s11606-020-06385-x.
Pilla SJ, Park J, Schwartz JL, Albert MC, Ephraim PL, Boulware LE, Mathioudakis NN, Maruthur NM, Beach MC, Greer RC. Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes. J Gen Intern Med. 2021 Jun;36(6):1533–1542.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

June 2021

Volume

36

Issue

6

Start / End Page

1533 / 1542

Location

United States

Related Subject Headings

  • Quality of Life
  • Primary Health Care
  • Insulin
  • Hypoglycemic Agents
  • Hypoglycemia
  • Humans
  • General & Internal Medicine
  • Diabetes Mellitus, Type 2
  • Diabetes Mellitus
  • Communication