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Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review
Author(s) -
Berkowitz Seth A.,
Aragon Katherine,
Hines Jonas,
Seligman Hilary,
Lee Sei,
Sarkar Urmimala
Publication year - 2013
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12048
Subject(s) - medicine , hypoglycemia , glycemic , medline , diabetes mellitus , data extraction , family medicine , intensive care medicine , endocrinology , political science , law
Objective To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients. Data Sources MEDLINE , the N ational G uidelines C learinghouse, the N ational Q uality M easures C learinghouse, 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.