Andrew Willis1, Helen Dallosso2, Laura Gray3, June James4, Cat Taylor5, Melanie Davies6, Debbie Shaw7, Niroshan Siriwardena8, Kamlesh Khunti9. 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.
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.
Authors: Francesca R Elwen; Alice Huskinson; Linda Clapham; Matthew J Bottomley; Simon R Heller; Cathryn James; Afroze Abbas; Paul Baxter; Ramzi A Ajjan Journal: BMJ Open Diabetes Res Care Date: 2015-06-30
Authors: Jonathan Green; Maria Robinson; Richard Pilbery; Gregory Whitley; Helen Hall; Madeleine Clout; Barnaby Reeves; Kim Kirby; Jonathan Benger Journal: Br Paramed J Date: 2020-06-01
Authors: Stephanie Armstrong; Adele Langlois; Despina Laparidou; Mark Dixon; Jason P Appleton; Philip M Bath; Helen Snooks; A Niroshan Siriwardena Journal: BMC Med Res Methodol Date: 2017-09-16 Impact factor: 4.615