Geographic Disparities in Glucagon Prescriptions Across North Carolina.

Introduction: Geographic disparities in healthcare access cause substantial difficulties for patients with diabetes, particularly in accessing emergency medicines such as glucagon. In this study, we examine the spatial distribution of glucagon, insulin, and sulfonylureas prescription claims for Medicaid recipients in North Carolina (NC) counties and consider how these differences affect the management of diabetes and public health policy.

Methods: Glucagon, insulin, and sulfonylureas claim counts in each NC county as reported by the NC Medicaid from January 2022 to July 2023 were used. We also used the medical provider density data, county classification data, and pharmacy data, all at the county level, for the state of North Carolina. We compared prescribing patterns across urbanicity categories using descriptive statistics and investigated spatial patterns using data visualization.

Results: Of the 100 NC counties, 38% had zero glucagon claims reported, and all were rural counties. Compared to rural counties, the average number of claims were higher in urban areas, insulin (922.2 vs 120.7), glucagon (123.7 vs 14.6), and sulfonylureas (10.0 vs 2.8). The study revealed significant disparities in diabetes care across North Carolina, with rural counties reporting the lowest glucagon, insulin, and sulfonylureas claims. Urban counties had higher healthcare provider densities and medication claims, with urban areas being 7.6 times more likely to report insulin claims than rural areas, highlighting geographic inequities in care access.

Conclusions: By emphasizing the significance of addressing glucagon prescribing trends, this analysis recommends focused efforts to promote the equitable distribution of life-saving medicines for severe hypoglycemia.