Reduction in cardiovascular mortality following severe hypoglycemia in individuals with type 2 diabetes: the role of a pragmatic and structured intervention : Structured intervention for community hypoglycemia.
Cardiovasc Diabetol
; 20(1): 18, 2021 01 12.
Article
em En
| MEDLINE
| ID: mdl-33435992
ABSTRACT
BACKGROUND:
Mortality in individuals with diabetes with severe hypoglycemia requiring ambulance services intervention is high and it is unclear whether this is modifiable. Our aim was to characterise this high-risk group and assess the impact of nurse-led intervention on mortality.METHODS:
In this single centre study, patients with diabetes and hypoglycemia requiring ambulance call out were randomized to nurse led support (intensive arm) or managed using existing pathways (standard arm). A third group agreed to have their data collected longitudinally (observational arm). The primary outcome was all-cause mortality comparing intensive with combined standard and observational arms as well as standard arm alone.RESULTS:
Of 828 individuals identified, 323 agreed to participate with 132 assigned to intensive, 130 to standard and 61 to observational arms. Mean follow up period was 42.6 ± 15.6 months. Mortality in type 1 diabetes (n = 158) was similar across study arms but in type 2 diabetes (n = 160) this was reduced to 33% in the intensive arm compared with 51% in the combined arm (p = 0.025) and 50% in the standard arm (p = 0.06). Cardiovascular deaths, the leading cause of mortality, was lower in the intensive arm compared with combined and standard study arms (p < 0.01).CONCLUSIONS:
Medium-term mortality following severe hypoglycemia requiring the assistance of emergency services is high in those with type 2 diabetes. In individuals with type 2 diabetes, nurse-led individualized intervention reduces cardiovascular mortality compared with standard care. Large-scale multicentre studies are warranted to further investigate this approach. Trial registration The trial was retrospectively registered on http//www.clinicaltrials.gov with reference NCT04422145.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Glicemia
/
Doenças Cardiovasculares
/
Diabetes Mellitus Tipo 1
/
Diabetes Mellitus Tipo 2
/
Hipoglicemia
/
Hipoglicemiantes
/
Serviço Hospitalar de Enfermagem
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article