Acceptability and Feasibility of a Primary Care Hypoglycemia Prevention Program: A Pilot Study

<jats:p>&lt;p dir="ltr"&gt;&lt;b&gt;Objective:&lt;/b&gt; Hypoglycemia, a major cause of morbidity for people with diabetes, is underrecognized in primary care, leading to underutilization of risk mitigation strategies. This study reports the development and acceptability/feasibility testing of the Hypoglycemia Prevention Program (HPP), an electronic health record integrated toolkit for primary care.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Research Design and Methods:&lt;/b&gt; The HPP was developed through stakeholder engagement, and included a pre-visit hypoglycemia history survey, primary care provider (PCP) hypoglycemia toolkit, and patient self-management handout. The HPP pilot study was a pre-post clinical trial at one primary care practice. Participants were adults with diabetes treated with insulin or sulfonylureas, their PCPs and clinic staff. The primary outcome was acceptability; exploratory outcomes included pre- to post-intervention change in PCP hypoglycemia prevention actions, self-reported hypoglycemia and optional blinded 10-day continuous glucose monitoring (CGM).&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Results:&lt;/b&gt; The intervention was completed by 31 of 35 enrolled people with diabetes (89%) for whom it triggered frequent hypoglycemia alerts. The intervention was rated acceptable or completely acceptable by 87% of people with diabetes and 100% of participating PCPs (N=12) and clinic staff (N=5). PCPs increased indicated glucagon prescribing from pre- to post-intervention (0% to 32%, p=0.003); there were small increases in CGM initiation and deintensification of hypoglycemia-causing medications. Self-reported and CGM-detected hypoglycemia decreased from pre- to post-intervention, although with incomplete ascertainment and low CGM participation (N=11).&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Conclusions:&lt;/b&gt; A hypoglycemia prevention program designed for primary care is feasible to implement and acceptable to clinical and patient stakeholders, with evidence of improved hypoglycemia prevention efforts. Further efficacy evaluation is needed.&lt;/p&gt;&lt;p&gt;&lt;br&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Clinical Trials Registration:&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;ClinicalTrials.gov number NCT06353217&lt;/p&gt;&lt;p dir="ltr"&gt;https://clinicaltrials.gov/study/NCT06353217&lt;/p&gt;&lt;p&gt;&lt;br&gt;&lt;/p&gt;&lt;p&gt;&lt;br&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Article Highlights&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;· &lt;b&gt;Why did we undertake this study?&lt;/b&gt; We developed the Hypoglycemia Prevention Program (HPP), an electronic health record integrated toolkit, to address current gaps in hypoglycemia prevention in primary care.&lt;/p&gt;&lt;p dir="ltr"&gt;· &lt;b&gt;What is the specific question we wanted to answer?&lt;/b&gt; We evaluated the acceptability and feasibility of the HPP among people with diabetes at risk for hypoglycemia, their primary care providers, and clinic staff.&lt;/p&gt;&lt;p dir="ltr"&gt;· &lt;b&gt;What did we find? &lt;/b&gt;Stakeholders developed the HPP tools, which included a hypoglycemia assessment survey, clinical alerts and orders, and patient education. The HPP was feasible to implement and highly acceptable to patient and clinical stakeholders.&lt;/p&gt;&lt;p dir="ltr"&gt;· &lt;b&gt;What are the implications of our findings? &lt;/b&gt;The HPP is a promising intervention to promote hypoglycemia risk reduction in primary care practice and should be evaluated for clinical efficacy.&lt;/p&gt;</jats:p>