Aims: The aim of this work is to provide in depth characterization of patients with type 2 diabetes (T2D) with severe hypoglycemia and assess the role of structured nurse-led intervention on clinical outcome.
Methods: Individuals with T2D and severe hypoglycemia requiring ambulance services assistance were recruited into the study. Participants were randomized into standard arm (n=64), managed using existing pathways, or intervention arm (n=60), receiving nurse-led support for a period of 90 days. A third group did not wish to participate in the interventional study but consented for their data to be collected and were analyzed separately (observational arm; n=36).
Results: Of the 160 participants, 88 were men and median age was 77.0 (IQR 69.3-82.0) years. Mean HbA1c±SD was 59.7±16.1 mmol/mol and capillary glucose levels at ambulance crew arrival was 2.2±0.75 mmol/L. HbA1c, smoking status, age and presenting glucose were similar in the standard and intervention arms. 9 participants withdrew or lost to follow-up and were excluded from analysis. Individuals were followed-up for a median of 1350 days (IQR 870-1627) and mortality occurred in 67 participants (44.4%), with cardiovascular events as the leading cause (34%) followed by infections (27%). The number of deaths in the intervention arm was 17 (32%) compared with 31 (50%) in conventionally managed individuals (p=0.047), mainly due to a reduction in cardiovascular mortality [1 (2%) and 11 (18%), respectively; p<0.01]. Individuals in the observational and standard arms had similar mortality rate.
Discussion: This pilot study demonstrates that cardiovascular events and infections are the main cause of mortality following severe hypoglycemia in the community requiring ambulance services assistance. A structured nurse-led intervention for 3 months reduces mortality primarily due to a decrease in cardiovascular events.
S. Pearson: Speaker's Bureau; Self; Novo Nordisk Inc. K. Kulavarasalingam: None. P. Baxter: None. A.K. Mitchell-Gears: Other Relationship; Self; Heart Research UK. B.A. Whittam: None. R. Ajjan: Consultant; Self; Abbott. Research Support; Self; Abbott, LifeScan, Inc.