Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review.

Berkowitz SA, Aragon K, Hines J, Seligman H, Lee S, Sarkar U.

Source

Division of General Internal Medicine, Massachussets General Hospital, Boston, MA 02114.

Abstract

OBJECTIVE:

To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients.

DATA SOURCES:

MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources.

STUDY DESIGN:

Systematic review of clinical standards (guidelines, quality metrics, or pay-for-performance programs) for glycemic control in adult diabetes patients. The primary outcome was discussion of increased risk for hypoglycemia in vulnerable populations.

DATA COLLECTION/EXTRACTION METHODS:

Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form.

PRINCIPAL FINDINGS:

We screened 1,166 titles, and reviewed 220 manuscripts in full text. Forty-four guidelines, 17 quality metrics, and 8 pay-for-performance programs were included. Five (11 percent) guidelines and no quality metrics or pay-for-performance programs met the primary outcome.

CONCLUSIONS:

Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations.
© Health Research and Educational Trust.