Randomised controlled trial of an innovative hypoglycaemia pathway for self-care at home and admission avoidance: a partnership approach with a regional ambulance trust

Andrew Willis; Helen Dallosso; Laura Gray; June James; Cat Taylor; Melanie Davies; Debbie Shaw; Niroshan Siriwardena; Kamlesh Khunti

doi:10.29045/14784726.2022.03.6.4.3

Randomised controlled trial of an innovative hypoglycaemia pathway for self-care at home and admission avoidance: a partnership approach with a regional ambulance trust

Br Paramed J. 2022 Mar 1;6(4):3-10. doi: 10.29045/14784726.2022.03.6.4.3.

Authors

Andrew Willis¹, Helen Dallosso², Laura Gray³, June James⁴, Cat Taylor⁵, Melanie Davies⁶, Debbie Shaw⁷, Niroshan Siriwardena⁸, Kamlesh Khunti⁹

Affiliations

¹ University of Leicester; NIHR Applied Research Collaboration East Midlands (ARC-EM) ORCID iD: https://orcid.org/0000-0002-9671-2162.
² University Hospitals of Leicester NHS Trust; NIHR Applied Research Collaboration East Midlands (ARC-EM) ORCID iD: https://orcid.org/0000-0002-6732-0864.
³ University of Leicester ORCID iD: https://orcid.org/0000-0002-9284-9321.
⁴ University Hospitals of Leicester NHS Trust.
⁵ University of Leicester.
⁶ University Hospitals of Leicester NHS Trust; NIHR Leicester Biomedical Research Centre ORCID iD: https://orcid.org/0000-0002-9987-9371.
⁷ East Midlands Ambulance Service NHS Trust.
⁸ East Midlands Ambulance Service NHS Trust; University of Lincoln ORCID iD: https://orcid.org/0000-0003-2484-8201.
⁹ University of Leicester; NIHR Applied Research Collaboration East Midlands (ARC-EM) ORCID iD: https://orcid.org/0000-0003-2343-7099.

Abstract

Background: Hypoglycaemia is a common and potentially life-threatening condition in people with diabetes, commonly caused by medications such as insulin. Hypoglycaemic events often require in-patient treatment and/or follow-up with a diabetes specialist nurse (DSN) or GP to make adjustments to medication. This referral pathway commonly relies on patient self-referral to primary care, and as a result many patients are not actively followed up and go on to experience repeat hypoglycaemic events.

Methods: Randomised controlled trial in partnership with East Midlands Ambulance Service NHS Trust. People with diabetes calling out an ambulance for a severe hypoglycaemic episode and meeting the eligibility criteria were randomised to either a novel DSN-led pathway or to their general practice for routine follow-up. Primary outcome was proportion of participants with a documented consultation with a healthcare professional to discuss the management of their diabetes within 28 days of call-out.

Results: 162 people were randomised to one of the pathways (73 DSN arm, 89 GP arm) with 81 (50%, 35 DSN, 46 GP) providing full consent to be followed up. Due to lower than anticipated randomisation and consent rates, the recruitment target was not met. In the 81 participants who provided full consent, there were higher rates of consultation following the call-out when referred to a DSN compared to primary care (90% vs. 65%). Of the 81 participants, 26 (32%) had a second call-out within 12 months.

Conclusions: Consultation rates following the call-out were high in the DSN-led arm, but there was insufficient power to complete the planned comparative analysis. The study highlighted the difficulty in recruitment and delivery of research in pre-hospital emergency care. Further work is needed to provide more feasible study designs and consent procedures balancing demands on ambulance staff time with the need for robust well-designed evaluation of referral pathways.

Keywords: diabetes management; hypoglycaemia; pre-hospital research.