Digitalization of HYPOGLYRISK and Evaluation of Its Utility for Pharmacist-Led Hypoglycemia Risk Assessment in Type 2 Diabetes Mellitus
DOI:
https://doi.org/10.36733/medicamento.v12i1.13619Keywords:
Ambulatory, HYPOGLYRISK, Hypoglycemia, Patient Safety, Pharmacists, T2DMAbstract
Background: We developed a tool for pharmacists to facilitate screening of medication-related hypoglycemia risk in patients with type 2 diabetes mellitus (T2DM), called HYPOGLYRISK. Although this instrument has been validated and proven reliable, the paper-based version was considered inefficient and prone to human error during routine screening.
Objective: This study aimed to digitalize HYPOGLYRISK and evaluate its utility compared with the printed version.
Methods: A mixed-method study design combining software development and a quasi-experimental trial was used. In the development stage, the application was created using Android Studio and validated through Black Box Testing and User Acceptance Testing (UAT). In the trial stage, 46 pharmacists participated and were divided into two groups using either the digital or paper-based HYPOGLYRISK to assess simulated ambulatory T2DM patients representing different hypoglycemia risk categories. The primary outcome was assessment time efficiency, while the secondary outcome was the potential for human error. Data were analyzed using the Mann-Whitney U test, chi-square test, and relative risk analysis.
Results: The digital HYPOGLYRISK demonstrated significantly shorter assessment time compared with the conventional version (p<0.05) and reduced the probability of scoring errors by 3.3 times (p<0.05). The digital application also provided additional advantages, including efficiency, scalability, ease of use, rapid data access, and simplified data management.
Conclusion: These findings suggest that digital HYPOGLYRISK can enhance pharmacist-led hypoglycemia risk assessment among ambulatory patients with T2DM.
References
1. Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia Among Patients with Type 2 Diabetes: Epidemiology, Risk Factors, and Prevention Strategies. Curr Diab Rep. 2018;18(8):53. doi:10.1007/s11892-018-1018-0
2. Shabestari M, Mehrabbeik A, Barbieri S, Marques-Vidal P, Heshmati-nasab P, Azizi R. Predictive factors of hypoglycemia in type 2 diabetes: a prospective study using machine learning. Sci Rep. 2025;15(1):18143. doi:10.1038/s41598-025-03030-7
3. Fan YP, Lai TH, Lai JN, Yang CC. Impacts of medication adherence and home healthcare on the associations between polypharmacy and the risk of severe hypoglycemia among elderly diabetic patients in Taiwan from 2002 to 2012: A nationwide case-crossover study. Geriatr Nurs (Minneap). 2024;58:8-14. doi:10.1016/j.gerinurse.2024.04.024
4. Giorda CB, Orsi E, De Cosmo S, Bossi AC, Guerzoni C, Cercone S, Gilio B, Cavalot F. Prescription of Sulphonylureas among Patients with Type 2 Diabetes Mellitus in Italy: Results from the Retrospective, Observational Multicentre Cross-Sectional SUSCIPE (Sulphonyl_UreaS_Correct_Internal_Prescription_Evaluation) Study. Diabetes Ther. 2020;11(9):2105-2119. doi:10.1007/s13300-020-00871-5
5. Moon Z, Walsh J. Digital interventions in medication adherence: a narrative review of current evidence and challenges. Front Pharmacol. 2025;16(1):1632474. doi:10.3389/fphar.2025.1632474
6. Insani WN, Zakiyah N, Puspitasari IM, Permana MY, Parmikanti K, Rusyaman E, Suwantika AA. Digital Health Technology Interventions for Improving Medication Safety: Systematic Review of Economic Evaluations. J Med Internet Res. 2025;27(1):e65546. doi:10.2196/65546
7. Ikawati Z, Adi Jaya MK, Rahmawati F, Yasin NM. Evaluation of Insulin and Sulfonylurea Types on Severe Hypoglycemia Event Among Ambulatory Type 2 Diabetes Mellitus Patients. A Case-Control Hospital-Based Study in Bali. Biomed Pharmacol J. 2024;17(4):2249-2257. doi:10.13005/bpj/3021
8. Jaya MKA, Rahmawati F, Yasin NM, Ikawati Z. Development and Validation of an Instrument to Assess the Safe Use of Antidiabetic Medication to Prevent Hypoglycemia Requiring Hospitalization Among Ambulatory Patients With Type 2 Diabetes Mellitus in Bali, Indonesia. J Prev Med Public Heal. 2025;58(1):52-59. doi:10.3961/jpmph.24.424
9. Jaya MKA, Rahmawati F, Yasin NM, Ikawati Z. Determination, Validation, and Development of Prediction Scores Related to Hypoglycemia Risk Factors Among Ambulatory Type 2 Diabetes Mellitus Patients in Bali, Indonesia. Curr Diabetes Rev. Published online 2025. doi:10.2174/0115733998375680250509052027
10. Jaya M, Rahmawati F, Yasin N, Ikawati Z. A case-control study on factors associated with hypoglycemia unawareness among the ambulatory type 2 diabetes mellitus patients in Bali, Indonesia. Trop J Pharm Res. 2025;24(1):109-116.
11. Abiy R, Gashu K, Asemaw T, Mitiku M, Fekadie B, Abebaw Z, Mamuye A, Tazebew A, Teklu A, Nurhussien F, Kebede M, Fritz F, Tilahun B. A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data? Online J Public Health Inform. 2018;10(2):e212. doi:10.5210/ojphi.v10i2.8309
12. Murphy C, Keogh IJ. The evolution of the medical record from paper to digital: an ENT perspective. J Laryngol Otol. 2023;137(3):246-248. doi:10.1017/S0022215122002018
13. Ibrahim AA, Ahmad Zamzuri M ‘Ammar I, Ismail R, Ariffin AH, Ismail A, Muhamad Hasani MH, Abdul Manaf MR. The role of electronic medical records in improving health care quality: A quasi-experimental study. Medicine (Baltimore). 2022;101(30):e29627. doi:10.1097/MD.0000000000029627
14. Tsai J, Bond G. A comparison of electronic records to paper records in mental health centers. Int J Qual Heal Care. 2007;20(2):136-143. doi:10.1093/intqhc/mzm064
15. Stausberg J, Koch D, Ingenerf J, Betzler M. Comparing paper-based with electronic patient records: lessons learned during a study on diagnosis and procedure codes. J Am Med Inform Assoc. 2003;10(5):470-477. doi:10.1197/jamia.M1290
16. Sujarwoto S, Augia T, Dahlan H, Sahputri RAM, Holipah H, Maharani A. COVID-19 Mobile Health Apps: An Overview of Mobile Applications in Indonesia. Front Public Heal. 2022;10. doi:10.3389/fpubh.2022.879695
17. Pratama MP, Ervianti E. Development of Android-Based Interactive Media in Educational Teknologi UKI Toraja. In: 2024:831-840. doi:10.2991/978-2-38476-301-6_81
18. Maharani A, Sujarwoto, Praveen D, Oceandy D, Tampubolon G, Patel A. Implementation of mobile-health technology is associated with five-year survival among individuals in rural areas of Indonesia. PLOS Digit Heal. 2024;3(4):e0000476. doi:10.1371/journal.pdig.0000476
19. Nuraga Budiman A, Wicaksono H, Suyana H. A Comparative Study Of Consumers As Users Of Ios And Android Smartphones In Jakarta. J Edusci. 2025;2(4):318-334. doi:10.62885/edusci.v2i4.632
20. Adi Jaya MK, Rahmawati F, Yasin NM, Ikawati Z. Pharmacist’s perceived barriers in providing counseling services to ambulatory type 2 diabetes mellitus patients: A qualitative phenomenological study in Bali, Indonesia. J Appl Pharm Sci. 2025;15(9):85-96. doi:10.7324/JAPS.2025.233011
21. Zulkarnaini, Firdhayanti A, Taufik T, Bachry B. User Acceptance Testing through Blackbox Evaluation for Corn Distribution Information System. bit-Tech. 2023;6(2):208-215. doi:10.32877/bt.v6i2.1065
22. Bahtiar AR, Ramadhani RD, Anto N, Muna BL. User Acceptance Test Aplikasi Mobile SI CANTIK BANGSA untuk Pencatatan Kesetaraan Gender dalam Pembangunan Desa. JITU J Inform Technol Commun. 2024;8(1):1-10. doi:10.36596/jitu.v8i1.1376
23. Des Jarlais DC, Lyles C, Crepaz N, TREND Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health. 2004;94(3):361-366. doi:10.2105/ajph.94.3.361
24. Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152(11):726-732. doi:10.7326/0003-4819-152-11-201006010-00232
25. Jiang Y, Hwang M, Cho Y, Friese CR, Hawley ST, Manojlovich M, Krauss JC, Gong Y. The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study. J Med Internet Res. 2024;26(1):e47685. doi:10.2196/47685
26. Ong SW, Jassal S V., Porter EC, Min KK, Uddin A, Cafazzo JA, Rac VE, Tomlinson G, Logan AG. Digital Applications Targeting Medication Safety in Ambulatory High-Risk CKD Patients. Clin J Am Soc Nephrol. 2021;16(4):532-542. doi:10.2215/CJN.15020920
27. Lichtner V, Gerrett D, Slee A, Gul N, Cornford T. The Role of Technology in Medication Safety Incidents: Interpretative Analysis of Patient Safety Incidents Data. Stud Health Technol Inform. 2017;245(1):1369.
28. Agrawal A. Medication errors: prevention using information technology systems. Br J Clin Pharmacol. 2009;67(6):681-686. doi:10.1111/j.1365-2125.2009.03427.x
29. Leon C, Hogan H, Jani YH. Identifying and mapping measures of medication safety during transfer of care in a digital era: a scoping literature review. BMJ Qual Saf. 2024;33(3):173-186. doi:10.1136/bmjqs-2022-015859
30. Forni A, Chu H, Fanikos J. Technology Utilization to Prevent Medication Errors. Curr Drug Saf. 2010;5(1):13-18. doi:10.2174/157488610789869193
31. Al Mahmud A, Joachim S, Jayaraman PP, Learmonth C, Tyagi S, Forkan ARM, Shuakat M, Wickramasinghe N, Wheeler J, Best S, Trainer A. Digital Health Interventions to Support Chronic Disease Management: Systematic Scoping Review. JMIR mHealth uHealth. 2026;14(1):e63742. doi:10.2196/63742
32. Peyroteo M, Lapão LV. Strategic scenarios for the digitalisation of chronic disease care management: A 10-year foresight case study in Lisbon’s primary healthcare setting. Technol Forecast Soc Change. 2025;220(1):124290. doi:10.1016/j.techfore.2025.124290
33. Hu S, Song D, Wan S, Zhang S, Luo C, Li N, Liu G, Graça Espírito Santo Vasconcelos J da, de Carvalho LLC, Neobísi E, da Costa MLB, Etchu Takounjou J, Neves KM Das, dos Ramos da Conceição L, da Costa Encarnação M, Zhao LY. Digital health: current applications, challenges, and future directions for enhancing healthcare quality and safety. Front Public Heal. 2025;13. doi:10.3389/fpubh.2025.1646802
34. Rabbani MG, Alam A, Prybutok VR. Digital Health Transformation Through Telemedicine (2020–2025): Barriers, Facilitators, and Clinical Outcomes—A Systematic Review and Meta-Analysis. Encyclopedia. 2025;5(4):206. doi:10.3390/encyclopedia5040206
35. Menteri Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 72 Tahun 2016 tentang Standar Pelayanan Kefarmasian di Rumah Sakit. Direktur Jenderal Peraturan Perundang-Undangan Kementerian Hukum dan Hak Asasi Manusia Republik Indonesia. Preprint posted online 2016:63.
36. Despott RA, Vella Bonanno P, Gauci C. Risk Management of Medication Errors: Improving the Quality of Pharmacotherapeutic Practice. Pharmacol Res Perspect. 2025;13(3):e70093. doi:10.1002/prp2.70093
37. Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc. 2008;15(5):585-600. doi:10.1197/jamia.M2667
Downloads
Submitted
Accepted
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Made Krisna Adi Jaya, Zullies Ikawati, Fita Rahmawati, Nanang Munif Yasin, I Gusti Ngurah Anom Cahyadi Putra
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
