Prefecture-Level Prehospital Glucose Administration for Hypoglycemia and Diabetologist Density Among Older Adults in Japan: A Nationwide Ecological Study.
Geriatrics & gerontology international · 2026-07-01 · Observational study
Abstract
AIMS: To assess prefecture-level disparities in prehospital glucose administration for hypoglycemia among older adults, diabetologist density, and insulin prescribing, and to examine the association between diabetologist density and prehospital glucose administration in Japan. METHODS: We conducted a nationwide ecological cross-sectional study across all 47 prefectures. Prehospital glucose administration for hypoglycemia was identified from national Emergency Medical Service statistics (2022). Diabetologist density (certified diabetologists per 100 000 population) was obtained from the Japan Diabetes Society specialist list. Prescribing patterns were derived from the Musubi electronic medication history database (January 2019 to June 2025) and summarized as the proportion of insulin prescriptions among glucose-lowering drugs. Pearson correlation coefficients were calculated. RESULTS: Rates of prehospital glucose administration for hypoglycemia varied substantially across prefectures (approximately 10-fold between the highest and lowest). Diabetologist density was inversely correlated with prehospital glucose administration per 100 000 population (r = -0.331, p < 0.05) and per 1000 EMS patients (r = -0.425, p < 0.05); the inverse correlation per 1000 patients with diabetes was not statistically significant (r = -0.274, p = 0.062). Although diabetologist density was positively correlated with insulin prescribing proportion (r = 0.326, p < 0.05), it was inversely correlated with prehospital glucose administration. CONCLUSIONS: Marked geographic disparities in prehospital glucose administration for hypoglycemia were observed in Japan. Higher diabetologist density was associated with lower rates of prehospital glucose administration, despite a higher proportion of insulin prescribing, supporting efforts to improve access to certified diabetologists and strengthen diabetologist-primary care collaboration.
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Tags
Equity & disparities · Fluids & blood · Glucose · Older adults · Rural & remote
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