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Health Serv Res. 2013 Aug;48(4):1299-310. doi: 10.1111/1475-6773.12048. Epub 2013 Feb 28.

Do clinical standards for diabetes care address excess risk for hypoglycemia in vulnerable patients? A systematic review.

Author information

1
Division of General Internal Medicine, Massachussets General Hospital, Boston, MA 02114, USA. SABerkowitz@partners.org

Abstract

OBJECTIVE:

To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients.

DATA SOURCES:

MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, 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.

KEYWORDS:

Diabetes mellitus; clinical guidelines; health disparities; quality and safety; vulnerable populations

PMID:
23445498
PMCID:
PMC3725526
DOI:
10.1111/1475-6773.12048
[Indexed for MEDLINE]
Free PMC Article
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