A retrospective observational study of people with Type 1 diabetes with self-reported severe hypoglycaemia reveals high level of ambulance attendance but low levels of therapy change and specialist intervention

B C T Field; R Nayar; A Kilvert; M Baxter; J Hickey; M Cummings; S C Bain

doi:10.1111/dme.13670

A retrospective observational study of people with Type 1 diabetes with self-reported severe hypoglycaemia reveals high level of ambulance attendance but low levels of therapy change and specialist intervention

Diabet Med. 2018 May 15. doi: 10.1111/dme.13670. Online ahead of print.

Authors

B C T Field^{1

2}, R Nayar³, A Kilvert⁴, M Baxter⁵, J Hickey⁶, M Cummings⁷, S C Bain⁸

Affiliations

¹ Endocrinology and Diabetes, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, UK.
² Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.
³ Endocrinology, Sunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK.
⁴ Diabetes Centre, Northampton General Hospital, Northampton NHS Trust, Northampton, UK.
⁵ Medical Affairs - Diabetes, Sanofi, Guildford, UK.
⁶ pH Associates, Marlow, UK.
⁷ Diabetes Centre, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK.
⁸ Diabetes Research Unit Cymru, Swansea University Medical School, Swansea, UK.

PMID: 29766565
DOI: 10.1111/dme.13670

Abstract

Aim: To evaluate the impact of severe hypoglycaemia on NHS resources and overall glycaemic control in adults with Type 1 diabetes.

Methods: An observational, retrospective study of adults (aged ≥ 18 years) with Type 1 diabetes reporting one or more episodes of severe hypoglycaemia during the preceding 24 months in 10 NHS hospital diabetes centres in England and Wales. The primary outcome was healthcare resource utilization associated with severe hypoglycaemia. Secondary outcomes included demographic and clinical characteristics, diabetes control and pathway of care.

Results: Some 140 episodes of severe hypoglycaemia were reported by 85 people during the 2-year observation period. Ambulances were called in 99 of 140 (71%) episodes and Accident and Emergency attendance occurred in 26 of 140 (19%) episodes, whereas 29 of 140 (21%) episode required no immediate help from healthcare providers. Participants attended a median of 5 (range 0-58) diabetes clinic consultations during the observation period; 13% (70 of 552) of all consultations were severe hypoglycaemia-related. Of the HbA_1c measurements recorded closest prior to severe hypoglycaemia (n = 119), only 7 of 119 measurements were < 48 mmol/mol (< 6.5%) and mean HbA_1c was 70 (sd 19) mmol/mol (8.5%, sd 1.7%). Some 119 changes to diabetes treatment were recorded during the observation period (median/person 0;, range 0-11), of which 52 of 119 changes (44%) followed severe hypoglycaemic events.

Conclusions: We observed a high level of ambulance service intervention but surprisingly low levels of hypoglycaemia follow-up, therapy change and specialist intervention in people self-reporting severe hypoglycaemia. These results suggest there may be important gaps in care pathways for people with Type 1 diabetes self-reporting severe hypoglycaemia.