557-P: Patient and Caregiver Experiences during Severe Hypoglycemia: A Qualitative Assessment

Among people with diabetes (PWD) using insulin, severe hypoglycemia (SH) can be a life threatening complication, if untreated. The personal experiences of SH from the perspective of PWD and their caregivers (CG) are not well characterized. This study assessed the perceptions of the event and decision-making processes of PWD (T1D n=36; T2D n=24) and their CGs during SH.

In-depth one-on-one telephone interviews were conducted with dyads of US PWD and CGs (n=120). An initial synopsis and inductive codebook schema were used to analyze the data with 2 independent coders (kappa=0.87-0.89). Themes were developed from the codes, and codes were re-mapped to the themes.

The four themes included: (1) CGs scramble to do the right thing and support PWD in treating SH. (2) Decision-making capacity is impaired during a SH event (SHE), often a panicked time. (3) Discussion with healthcare providers (HCPs) about SH, and particularly about treatment, is limited. (4) PWD and CGs learn to manage SH through their own experiences and frequently make lifestyle changes to prevent and treat future events. See Exhibit for details.

This study finds that SHEs are characterized by high intensity emotions for PWD and CGs that can impair decision-making. Additionally, much of PWD and CG knowledge about SH treatment derives from prior experience rather than HCP guidance, suggesting a need for more proactive discussions with HCPs regarding SH management.

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