8503 Analyzing Prescription Practices for Back-up Insulin and Glucagon in Type 1 Diabetes Patients Using Insulin Pumps: Findings From Cleveland Clinic

Abstract Disclosure: A. Iqbal: None. J. Ambalavanan: None. K. Alkwatli: None. P.P. Rao: None. Background: It is estimated that about 400,000 patients with type 1 diabetes (T1D) in the U.S. are using insulin pumps1. This number has been steadily increasing with expanding insurance coverage and newer, more convenient, user-friendly technology. Though these devices remarkably improve patients’ glycemic control, failure of these pumps, due to reasons such as clogging or kinking of tubing, air bubbles, pump display issues, site reaction/infection, is a frequently encountered problem. During these events, having a backup plan in the form of injectable insulin is essential to prevent severe hyperglycemia and diabetic ketoacidosis (DKA). Increasing insulin pump use also predisposes patients to severe hypoglycemia. In these cases, at-home glucagon administration can be lifesaving. Methods: Using the EPIC Cogito extracts and reporting service, data was extracted for adult patients seen at the Cleveland Clinic main campus between January 1, 2021, to January 1, 2023, using ICD codes for T1D and insulin pump status. Data collected included age, sex, prescription status for basal insulin, type of basal insulin, glucagon prescription, and current medication list.ResultsWe were able to analyze 86 patients (67% females, n=58; 33% male, n=28) with T1D utilizing an insulin pump. The average age was 48.6+18.18 years. Of the 86 patients, 51 (59%) had prescriptions for long-acting backup insulin. Only 21 patients (24%) had a prescription for glucagon. Discussion: Insulin pump failure is one of the most common causes of DKA in patients with T1D2. Educating patients on the use of long-acting injectable insulin in the event of pump failure and ensuring active prescription for every patient using an insulin pump at each visit can decrease the risk of DKA and prevent hospitalizations. Similarly, the use of a continuous subcutaneous insulin infusion (CSII) puts patients at high risk of hypoglycemia. Per Standards of Care in Diabetes 2024, glucagon should be prescribed in all patients using insulin3. Our analysis reveals that the practice of prescribing backup insulin and glucagon at Cleveland Clinic Institute needs significant improvement to potentially prevent DKA and severe hypoglycemia requiring hospitalization. References: 1Umpierrez GE, Klonoff DC. Diabetes Technology Update: Use of Insulin Pumps and Continuous GlucoseMonitoring in the Hospital. Diabetes Care. 2018 Aug;41(8):1579-1589. 2Doyle EA, Weinzimer SA, Tamborlane W. DKA Prevention and Insulin Pumps: Lessons Learned From a Large Pediatric Pump Practice. Sci Diabetes Self Manag Care. 2022. 3American Diabetes Association Professional Practice Committee; 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S111-S125. Presentation: 6/1/2024