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.

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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.