Do clinical standards for diabetes care address excess risk for hypoglycemia in vulnerable patients? A systematic review

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.

Keywords: Diabetes mellitus; clinical guidelines; health disparities; quality and safety; vulnerable populations.