Nurse-led intervention can reduce mortality risk after severe hypoglycemia
medwireNews: Assigning people with type 2 diabetes to 3 months of focused care with a specialist diabetes nurse after an episode of severe hypoglycemia reduces their risk for mortality over the following few years, research shows.
As reported at the Diabetes UK Professional Conference in Liverpool, study participants were recruited via ambulance crews who had been called out to treat them for severe hypoglycemia. Of the 323 who agreed to be randomized, 22% of those assigned to the nurse-led intervention died during an average 1230 days of follow-up, compared with 33% who received standard care.
The intervention lasted 3 months, during which a research nurse worked with each study participant to identify the underlying causes of their hypoglycemia episode and instigate changes to improve glucose control. Contact was weekly for the first month, every 2 weeks during the second month, and there was a final face-to-face contact during the third month.
On further analysis, the intervention was beneficial only for the 160 people with type 2 diabetes, who also had the highest mortality rate. Mortality rates were 33% versus 50% for those in the intervention and standard-care groups, respectively, whereas the 158 participants with type 1 diabetes had a 12% mortality rate regardless of which group they were assigned to.
The protective effect of the nurse-led intervention was driven by a significant reduction in cardiovascular disease mortality, reported Millie Mitchell-Gears (University of Leeds Medical School, UK).
This was a common cause of death among people with type 2 diabetes, at 29%, and whereas 12 patients in the standard-care group died of cardiovascular causes, this was true of just three in the intervention group.
Infections accounted for a further 29% of deaths, and old age or other causes for 42%, but these outcomes were not influenced by treatment assignation. In response to a question from the audience, Mitchell-Gears noted that the causes of death were similar in people with type 1 diabetes, despite the lack of effect of the intervention on mortality risk in this subgroup.
She noted, however, that this was a single-center study, and that multicenter studies are needed to see if the benefits on cardiovascular mortality for people with type 2 diabetes can be replicated.
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