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Should More EMS Responders Be Allowed to Give Glucagon?

Should More EMS Responders Be Allowed to Give Glucagon?

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For the treatment of hypoglycemia, glucagon may be underused in outpatient settings, researchers argued.

In a nationwide analysis, most states only permit paramedics to carry and administer glucagon for a severe hypoglycemia event — leaving around 76% of all emergency medical service providers unable to give the agent, reported Peter A. Kahn, MD, of Yale School of Medicine in New Haven, Connecticut, and colleagues.

In some states, emergency medical service responders aren’t even permitted to check blood glucose levels, according to a research letter online in Annals of Internal Medicine.

“Patients receiving insulin or certain oral hypoglycemic agents are at increased risk for hypoglycemia, which results in more than 100,000 emergency department visits incurring approximately $120 million in costs annually,” Kahn’s group wrote, adding that family members often routinely administer glucagon.

The analysis included cases of glucagon administration from the National EMS Information System between 2013 to 2015, as well as prescriptions of glucagon from 2014 Medicare Part D data.

Within this time frame, glucagon was administered in only 89,263 cases in a prehospital setting. Among such instances where glucagon was administered, the average response time to calls for emergency medical services was 15.34 minutes (SD 11.50). Of these, only 3,944 patients reported having any adverse events due to glucagon.

“Emergency medical service response times to episodes of hypoglycemia are crucial in the diabetes chain of survival,” the group wrote. “The average response time of more than 15 minutes suggests that policy changes may be needed, because such a delay coupled with policies preventing basic emergency medicine providers from administering glucagon may increase patients’ risk for neurologic sequelae, death, or both.”

Notably, dispatchers of emergency personnel correctly coded only 44.67% of such calls as a “diabetic problem,” which the authors suggest “potentially increase[es] the likelihood of dispatching providers who cannot administer this agent to patients with hypoglycemia.”

Among Medicare beneficiaries — around 11.6 million of whom reported having diabetes in 2014 — only about 0.2% were prescribed glucagon, with the average cost of a prescription tagged around $212. However, of such patients who filled glucagon prescriptions, the patients tended to have fewer emergency department visits due to hypoglycemia-related events.

Kahn’s group argued that all emergency personnel should have access to glucagon as well as proper training for safe administration.

“Ensuring access is an important opportunity to reduce morbidity, mortality, and health care costs. Diabetes specialists should work with emergency medical personnel to design curricula for the safe and effective use of glucagon nationwide,” the team concluded.

One of the three coauthors reported financial relationships outside the scope of the study with Onduo, Health Reveal, and Merck; neither of the other two coauthor reported any conflicts of interest.


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