title: Do clinical standards for diabetes care address excess risk for hypoglycemia in vulnerable patients? A systematic review.
abstract: OBJECTIVE
  To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients.
  
  
  METHODS
  MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources.
  
  
  METHODS
  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.
  
  
  METHODS
  Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form.
  
  
  RESULTS
  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.
authors: Division of General Internal Medicine, Massachussets General Hospital, Boston, MA 02114, USA. SABerkowitz@partners.org
authors: Seth A
authors: SA
authors: Berkowitz
authors: Katherine
authors: K
authors: Aragon
authors: Jonas
authors: J
authors: Hines
authors: Hilary
authors: H
authors: Seligman
authors: Sei
authors: S
authors: Lee
authors: Urmimala
authors: U
authors: Sarkar
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic / Q000592:standards; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards; D012307:Risk Factors
keywords: Diabetes mellitus; clinical guidelines; health disparities; quality and safety; vulnerable populations