Ambulance contacts for hypoglycemia ‘a missed opportunity’ to improve care
medwireNews: Ambulance call-outs for episodes of severe hypoglycemia do not consistently result in reviews of patients’ care, despite guideline recommendations, shows a study of diabetes patients in England and Wales.
Stephen Bain (Swansea University Medical School, UK) and colleagues identified a total 140 episodes of severe hypoglycemia in 85 patients with type 1 diabetes from 10 centers across a 2-year period, 99 (71%) of which resulted in an ambulance call-out. In an additional 10 cases, the patients attended the emergency department but without the involvement of an ambulance.
This finding supports “the prominent role of ambulance services in delivering, or facilitating access to, healthcare advice and support at a time when people (and carers) may be most receptive,” write the researchers in Diabetic Medicine.
However, this did not then consistently lead to review and adjustment of patients’ diabetes care, which they describe as “a missed opportunity to reduce future risk of hypoglycaemia.”
The study participants attended a median of five diabetes consultations over the 2 years, but just 70 (13%) of the total 552 consultations were recorded as being for hypoglycemia follow-up. This was despite many of these patients being high-risk, with 41% having more than one severe hypoglycemia episode during the study period.
Most of the hypoglycemia consultations took place soon after the event, with 32% being telephone consultations on the same day.
Over the 2 years, healthcare professionals recommended a total of 119 changes to patients’ diabetes care. Although hypoglycemia was the most common reason given for these changes, it nevertheless accounted for less than half of them (44%). The next most common specified reason was personal choice, accounting for 11% of changes; however, “not known” accounted for 26%.
For 72 of the hypoglycemia episodes, the researchers were able to examine diabetes care data for the 3 months preceding and following the event, finding that patients had more consultations in the months following their hypoglycemia episode, at 63% of the 109 consultations, compared with 26% before and 11% on the same day.
Furthermore, of the 40 changes made to these patients’ care, 73% occurred after the hypoglycemia episode, compared with 18% and 10% before and on the day, respectively.
But despite this, “there is no indication in our study of a sustained increase in frequency of review following severe hypoglycaemia,” say the researchers.
They add: “Therefore, despite considerable innovation in the development of effective pathways for automatic ambulance service referral of people with hypoglycaemia to primary, community and secondary care services for early follow-up, our results may suggest that specialist diabetes services are clinically unresponsive to (or remain unaware of) severe hypoglycaemic episodes.”
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