Hypoglycemia Risk Score

Why did you develop the Hypoglycemia Risk Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

The goal of the Hypoglycemia Risk Score was to facilitate population management efforts to target preventive care for diabetes patients at the highest risk of hypoglycemia. While providers are typically well aware of hypoglycemia risks in their type 1 diabetes (T1D) patients, the risk of type 2 diabetes (T2D) patients is more poorly understood. In fact, many providers are unaware of the level of risk in T2D patients despite more T2D patients experiencing hypoglycemia-related ED visits and hospitalizations than T1D patients.

What pearls, pitfalls and/or tips do you have for users of the Hypoglycemia Risk Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

The score was intended for population management rather than assigning a quantitative level of risk for an individual patient. This means you can identify groups of patients falling into the different levels of risk and target those groups to tailored, preventive management (e.g. hypoglycemia awareness training, continuous glucose monitoring, medication management).

What recommendations do you have for doctors once they have applied the Hypoglycemia Risk Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?

The identification of a higher risk patient is a first step that should be followed with a careful clinical review of the potential causes of hypoglycemia with the patient (e.g. meal skipping, hypoglycemia unawareness, insulin misadventures such as taking the wrong type of insulin, food insecurity, alcoholism). The appropriate intervention should be selected after the root cause(s) are established.

How do you use the Hypoglycemia Risk Score in your own clinical practice? Can you give an example of a scenario in which you use it?

It is intended to be used as a population management tool; for risk stratifying patients and to facilitate creation of a reporting workbench (list) of higher risk patients for nurse care/accountable population managers who reach out to these high risk patients. This outreach includes an evaluation of the root causes and selection of the appropriate specialty referral or intervention (e.g. endocrinology, clinical pharmacy, health education, social work).

Andrew J. Karter, PhD, is a research scientist at Kaiser Permanente Northern California. He is also an adjunct professor in the department of general internal medicine at UCSF and affiliate professor in the department of epidemiology at the University of Washington. Dr. Karter's research interests are focused on diabetes and its complications, including impacts on care from medication adherence, literacy, provider communications, IT, and language barriers.