Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review
Article first published online: 28 FEB 2013
© Health Research and Educational Trust
Health Services Research
Volume 48, Issue 4, pages 1299–1310, August 2013
How to Cite
Berkowitz, S. A., Aragon, K., Hines, J., Seligman, H., Lee, S. and Sarkar, U. (2013), Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review. Health Services Research, 48: 1299–1310. doi: 10.1111/1475-6773.12048
- Issue published online: 4 JUL 2013
- Article first published online: 28 FEB 2013
- Institutional National Research Service. Grant Number: T32HP10251
- Division of General Internal Medicine at Massachusetts General Hospital
- Agency for Health Care Research and Quality. Grant Number: K08HS017594
- National Center for Research Resources. Grant Number: KL2RR024130
- NIH/NCRR/OD UCSF-CTSI. Grant Numbers: KL2 RR024130, KL2RR024130
- National Center for Research Resources
- National Institute of Aging and the American Federation for Aging Research. Grant Number: K23AG040779
- Diabetes mellitus;
- quality and safety;
- health disparities;
- vulnerable populations;
- clinical guidelines
To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients.
MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources.
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.
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.
Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations.