# Improving Diabetes Safety

Title	Improving Diabetes Safety
Description	Percent of patients at risk for glycemia receiving bolus insulin receive glucagon. A higher score is better
Rationale	Many patients with diabetes are at risk for hypoglycemia, which can cause hospitalizations or death. Individuals using insulin, particularly meal-time, or bolus, are at increased risk for hypoglycemia.
Logic Model	[![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/MsJimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/MsJimage.png) This measure ensures patients at increased risk for hypoglycemia have appropriate treatment available.
Level of Analysis	Pharmacy (Patient)
Data Source	Pharmacy Data
Denominator Statement	Patient at risk for hypoglycemia due to bolus insulin use.
Denominator Calculation	1. 1. All individuals in the pharmacy 2. 2. All individuals prescribed a bolus insulin 3. 3. Exclude non-human patients.
Denominator Exclusions	Any non-human patients (e.g., cats, dogs, clinics, office-use, etc)
Denominator Exclusion Rationale	Pharmacies may provide care to pets or other veterinarian needs, or for office-use. This patient profiles should be excluded from the measure calculation.
Numerator Statement	Patients from the denominator with glucagon.
Numerator Calculation	1. Identify individuals from the denominator with a prescription for glucagon
Seguridad Measure Specification Process	[![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/vBjimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/vBjimage.png)
Data Stratification	The measure rate will be reported as a percent of patients within a single pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets	The value set Seguridad – Basal Insulin will be used to support the exclusion criteria.
Future Iterations	Many pharmacy measures are designed as structure or process. Future goals of this concept include measures will include other high-risk diabetes medications.
Harmonization¹	Payors: N/A Providers: N/A

1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures.