Use of glucagon in severe hypoglycemia is scarce in most countries, and has not been expanded by new ready-to-use glucagons

Antonio E Pontiroli; Manfredi Rizzo; Elena Tagliabue

doi:10.1186/s13098-022-00950-6

Use of glucagon in severe hypoglycemia is scarce in most countries, and has not been expanded by new ready-to-use glucagons

Diabetol Metab Syndr. 2022 Dec 23;14(1):193. doi: 10.1186/s13098-022-00950-6.

Authors

Antonio E Pontiroli¹, Manfredi Rizzo², Elena Tagliabue³

Affiliations

¹ Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Milan, Italy. antonio.pontiroli@unimi.it.
² Promise Department, School of Medicine, University of Palermo, Palermo, Italy.
³ Value-Based Healthcare Unit, IRCCS MultiMedica, Milan, Italy.

Abstract

Glucagon (traditional kits for intramuscular administration, Glucagon and Glucagen), although recommended as a remedy for severe hypoglycemia (SH), has been reported to be under-utilized, likely because of technical problems. The aims of this study were to evaluate the use of glucagon in persons with type 1 diabetes in several countries, and to investigate if the availability of new ready-to-use glucagons (Baqsimi, Gvoke, Zegalogue, years 2019 to 2021) has expanded the overall use of glucagon. The source of data was IQVIA-MIDAS (units of glucagon sold), while data on persons with type 1 diabetes in countries were derived from IDF Diabetes Atlas. The use of glucagon has been steady from 2014 to 2019, with a small but significant increase from 2019 to 2021, paradoxically only in countries where new ready-to-use glucagons were not available. The use of glucagon has always been ten fold greater in countries where new ready-to-use glucagons became available than in the other countries (population 108,000,000 vs 28,100,000, 480,291 vs 182,018 persons with type 1 diabetes). A significant correlation was observed in all years between units of glucagon and persons with type 1 diabetes. Availability of new ready-to-use glucagons was associated with a small increase of sales, due only to new ready-to-use glucagons themselves. The use of glucagon (any type) remains low, approximately 1/10 of persons with type 1 diabetes. We conclude that use of glucagon is scarce in most countries, and so far has not been expanded by new ready-to-use glucagons such as the ones considered in this study.

Keywords: Dasiglucagon; Emergency kits; Glucagon; Hypoglycemia; IDF diabetes atlas; IQVIA database; Nasal glucagon; Non-acqueous glucagon solutions; Persons with type 1 diabetes; Sales of glucagon units; Severe hypoglycemia.