Introduction and Objective: The American Diabetes Association recommends that glucagon be prescribed for all individuals taking insulin or at high risk for hypoglycemia (Grade A). However, among 5,656 adults with T1D who received care in our health system between 5/1/2022 - 4/30/2023, only 36.2% had an active glucagon prescription. To address this care gap, we developed and implemented an electronic health record (EHR)-based best practice alert (BPA) to increase glucagon prescribing for adults with T1D. Methods: The BPA targets adults with T1D without a glucagon prescription in the preceding 12 months. The BPA is interruptive and activates during ambulatory visits with Endocrinologists, Certified Diabetes Care and Education Specialists (CDCES), and Pharmacists upon order signing. The BPA provides hyperlinks to order intranasal or injectable glucagon and also includes the option to refer for pharmacy consultation to troubleshoot cost and/or insurance coverage. Providers may dismiss the alert with documentation of rationale. We implemented the BPA on 10/13/2025, and report descriptive statistics on glucagon prescribing through 12/11/2025. Results: Between 10/13/2025 - 12/11/2025, the BPA fired 303 times. Glucagon was prescribed in 48 instances (15.8%), with the intranasal formulation accounting for 79.2% (38/48) and injectable formulations for 20.8% (10/48). Endocrinologists prescribed 83.3% (40/48) of glucagon orders, followed by CDCES (12.5%, 6/48) and Pharmacists (4.2%, 2/48). The BPA was dismissed without glucagon prescription in 255 instances (84.2%). The most common documented reasons for non-prescribing included deferral to next visit, patient preference, and cost concerns. Conclusion: We successfully implemented an EHR-integrated BPA targeting glucagon prescribing for adults with T1D. However, the high dismissal rate (84.2%) highlights important barriers to prescribing. Stakeholder engagement will inform iterative modifications to the BPA and clinical processes in subsequent Plan-Do-Study-Act cycles. Disclosure F. Jovanovic: None. J.K. Batth: None. L. Chow: Research Support; Current; Dexcom, Inc. L.A. Burmeister: None. T. Harindhanavudhi: None. J. Kohlenberg: Research Support; Current; Dexcom, Inc. Advisory Panel; Current; Glooko, Inc. Other - Speaker for Med Learning Group (funded by Sanofi); Ended; Sanofi. Funding NIH NIDDK Diab-Docs (K12DK133995)
JOVANOVIC et al. (Fri,) studied this question.