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Diabetes and endocrinology
Research
Role and prevalence of impaired awareness of hypoglycaemia in ambulance service attendances to people who have had a severe hypoglycaemic emergency: a mixed-methods study
  1. Edward A S Duncan1,
  2. David Fitzpatrick2,
  3. Theresa Ikegwuonu3,
  4. Josie Evans4,
  5. Margaret Maxwell5
  1. 1 Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Faculty of Health Sciences and Sport, The University of Stirling, Stirling, UK
  2. 2 Faculty of Health Science and Sport, University of Stirling, Stirling, UK
  3. 3 Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  4. 4 Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
  5. 5 Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
  1. Correspondence to Dr Edward A S Duncan; edward.duncan{at}stir.ac.uk

Abstract

Objectives (1) To compare the experiences of people who are affected by diabetes-related hypoglycaemia and either do or do not require an emergency attendance and (2) to measure the prevalence of impaired awareness of hypoglycaemia in patients who are attended by an ambulance service due to a severe hypoglycaemic event.

Design A sequential mixed-methods study.

Setting A qualitative interview study was undertaken with 31 people with diabetes (types 1 and 2) resident in the central belt of Scotland. A national prevalence survey of 590 Scottish Ambulance Service patients who had recently experienced a severe hypoglycaemic emergency requiring ambulance clinicians attendance. Impaired awareness of hypoglycaemia was measured using two standardised measures.

Results Considerable differences in impaired awareness of hypoglycaemia were found in the experiences of participants who did or did not require the ambulance service to treat their severe hypoglycaemic events. Those who required an ambulance reported fewer warning signs and symptoms. The prevalence of impaired awareness of hypoglycaemia in ambulance service call-outs as assessed by two standardised measures was 53% and 60%, respectively.

Conclusions The prevalence of impaired awareness of hypoglycaemia among those who require an ambulance following a hypoglycaemic event is more than twice that found in the general population of people with diabetes. This may be because the experiences of impaired awareness in people who require an ambulance following a severe hypoglycaemic event differ to those who do not. This study provides important information to guide future prehospital clinical practice, and to develop and evaluate theoretically informed interventions. Improvements in prehospital care for this patient population could lead to global improvements in health outcomes and decreased service costs.

  • diabetes mellitus
  • hypolgycemia
  • ambulances
  • hypoglycaemia
  • paramedic

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-019522

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    Footnotes

    • Contributors The studies were coconceived by EASD, TI, DF and MM. All the authors contributed to elements of the study design. JE contributed expert advice to the design and quantitative analysis of the survey. TI and DF completed data collection. TI led the qualitative analysis. EASD led the quantitative analysis. All of the authors participated in the interpretation of the data. EASD led on the drafting of the manuscript. All authors revised the manuscript for important intellectual content, and read and approved the final manuscript.

    • Funding The study was funded by the Scottish Ambulance Service and the University of Stirling.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Ethical approval for both the qualitative and survey studies were received from the National Research Ethics Service (NRES) (11/AL/0330 and 15/EE/0383). ENHS research and development approval was gained from the Scottish Ambulance Service.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Both datasets are available from the corresponding author. There is no unpublished additional data.