The multinational  onversations and  eactions  round  evere  ypoglycemia (CRASH) study: Impact of health care provider communications and recommendations on people with diabetes

Snoek, Frank J.; Spaepen, Erik; Mojdami, Donna; Mönnig, Elisabeth; Syring, Kristen; Yan, Yu; Mitchell, Beth

doi:10.1016/j.jcte.2022.100295

Cited by 3 publications

(5 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results could reaffirm the moderating effects of COVID-19, although some pre-pandemic studies document greater use of SH-related parenteral therapy and longer in-hospital stays among patients with T2DM versus T1DM. 33,48,49 Speculated factors include deficient T2DM glucagon dispensation in the United States [50][51][52] and high uptake of secretagogues that, compared with insulin, can aggravate worse cognitive dysfunction and SH prolongation. 3,53 Future iNPHORM analyses will focus on pinpointing the exact causes of level 3 hypoglycaemia occurrence and associated variabil- Multiple strengths shore confidence in iNPHORM.…”

Section: Discussionmentioning

confidence: 99%

Severe (level 3) hypoglycaemia occurrence in a real‐world cohort of adults with type 1 or 2 diabetes mellitus (iNPHORM, United States)

Ratzki‐Leewing,

Black,

Kahkoska

et al. 2023

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

AimsAmong adults with insulin‐ and/or secretagogue‐treated diabetes in the United States, very little is known about the real‐world descriptive epidemiology of iatrogenic severe (level 3) hypoglycaemia. Addressing this gap, we collected primary, longitudinal data to quantify the absolute frequency of events as well as incidence rates and proportions.Materials and MethodsiNPHORM is a US‐wide, 12‐month ambidirectional panel survey (2020‐2021). Adults with type 1 diabetes mellitus (T1DM) or insulin‐ and/or secretagogue‐treated type 2 diabetes mellitus (T2DM) were recruited from a probability‐based internet panel. Participants completing ≥1 follow‐up questionnaire(s) were analysed.ResultsAmong 978 respondents [T1DM 17%; mean age 51 (SD 14.3) years; male: 49.6%], 63% of level 3 events were treated outside the health care system (e.g. by family/friend/colleague), and <5% required hospitalization. Following the 12‐month prospective period, one‐third of individuals reported ≥1 event(s) [T1DM 44.2% (95% CI 36.8%‐51.8%); T2DM 30.8% (95% CI 28.7%‐35.1%), p = .0404, α = 0.0007]; and the incidence rate was 5.01 (95% CI 4.15‐6.05) events per person‐year (EPPY) [T1DM 3.57 (95% CI 2.49‐5.11) EPPY; T2DM 5.29 (95% CI 4.26‐6.57) EPPY, p = .1352, α = 0.0007]. Level 3 hypoglycaemia requiring non‐transport emergency medical services was more common in T2DM than T1DM (p < .0001, α = 0.0016). In total, >90% of events were experienced by <15% of participants.ConclusionsiNPHORM is one of the first long‐term, prospective US‐based investigations on level 3 hypoglycaemia epidemiology. Our results underscore the importance of participant‐reported data to ascertain its burden. Events were alarmingly frequent, irrespective of diabetes type, and concentrated in a small subsample.

show abstract

Section: Discussionmentioning

confidence: 99%

Severe (level 3) hypoglycaemia occurrence in a real‐world cohort of adults with type 1 or 2 diabetes mellitus (iNPHORM, United States)

Ratzki‐Leewing,

Black,

Kahkoska

et al. 2023

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…Hypoglycemia is a major limiting factor in optimal glycemic management among patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) throughout the spectrum of the disease. Treatment with exogenous insulin is often associated with an increased risk of hypoglycemia [ 1 , 2 ]. Patients treated with insulin experience 1 severe hypoglycemic event per year on average or about 4.9 and 2.5 events/patient-year for T1D and T2D, respectively [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Treatment with exogenous insulin is often associated with an increased risk of hypoglycemia [ 1 , 2 ]. Patients treated with insulin experience 1 severe hypoglycemic event per year on average or about 4.9 and 2.5 events/patient-year for T1D and T2D, respectively [ 1 , 2 ]. Current guidelines, including those from the American Diabetes Association, Diabetes Canada, International Society for Pediatric and Adolescent Diabetes, European Association for the Study of Diabetes, and International Hypoglycaemia Study Group, among others [ 3-7 ], recommend treatment with glucagon for patients with diabetes who experience severe hypoglycemia and are unable or unwilling to consume oral carbohydrates.…”

Section: Introductionmentioning

confidence: 99%

Nasal Glucagon Reverses Insulin-induced Hypoglycemia With Less Rebound Hyperglycemia: Pooled Analysis of Clinical Trials

Seaquist,

Giménez,

Yan

et al. 2024

Journal of the Endocrine Society

View full text Add to dashboard Cite

Background Rebound hyperglycemia may occur following glucagon treatment for severe hypoglycemia. We assessed rebound hyperglycemia occurrence after nasal glucagon (NG) or injectable glucagon (IG) administration in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). Methods This was a pooled analysis of 3 multicenter, randomized, open-label studies (NCT03339453, NCT03421379, NCT01994746) in patients ≥18 years with T1D or T2D with induced hypoglycemia. Proportions of patients achieving treatment success (blood glucose [BG] increase to ≥70 mg/dL or increase of ≥20 mg/dL from nadir within 15 and 30 minutes); BG ≥70 mg/dL within 15 minutes; in-range BG (70-180 mg/dL) 1-2 and 1-4 hours postdose; and BG >180 mg/dL 1-2 and 1-4 hours postdose were compared. Incremental area under curve (iAUC) of BG >180 mg/dL and area under curve (AUC) of observed BG values postdose were analyzed. Safety was assessed in all studies. Results Higher proportions of patients had in-range BG with NG versus IG (1-2 hours: P =.0047; 1-4 hours: P =.0034). Lower proportions of patients had at least 1 BG value >180 mg/dL with NG versus IG (1-2 hours: P =.0034; 1-4 hours: P =.0068). iAUC and AUC were lower with NG versus IG (P =.025 and P <.0001). As expected, similar proportions of patients receiving NG or IG achieved treatment success at 15 and 30 minutes (97%-100%). Most patients had BG ≥70 mg/dL within 15 minutes (93%-96%). The safety profile was consistent with previous studies. Conclusion This study demonstrated lower rebound hyperglycemia risk after NG treatment compared with IG.

show abstract

“…3,6 Further, risk of severe hypoglycaemia may be contributed to by unpreparedness, impaired awareness of symptoms, and panic possibly delaying corrective action. 6,[7][8][9][10] People with diabetes can manage hypoglycaemia by ingesting fast-acting carbohydrates ('oral-carbs'). 1 However, there may be a brief window for action while transitioning from mild-moderate to severe hypoglycaemia, where the person maybe unable to swallow or tolerate oral-carbs.…”

Section: Introductionmentioning

confidence: 99%

“…As a person with advanced type 2 diabetes starts taking multiple daily insulin injections, the risk of a severe hypoglycaemic event is similar to a person with type 1 diabetes 3,6 . Further, risk of severe hypoglycaemia may be contributed to by unpreparedness, impaired awareness of symptoms, and panic possibly delaying corrective action 6,7–10 . People with diabetes can manage hypoglycaemia by ingesting fast‐acting carbohydrates (‘oral‐carbs’) 1 .…”

Section: Introductionmentioning

confidence: 99%

‘Didn't See the Need’: Misperceptions about glucagon from the perspectives of people with diabetes and their caregivers

et al. 2023

View full text Add to dashboard Cite

Aims Severe hypoglycaemia among people with diabetes who use insulin can be a life‐threatening complication if left untreated. Although glucagon has been approved for treatment of hypoglycaemia since the 1960s, it has been underutilized. We aimed to understand the perceptions of people with diabetes and their caregivers about glucagon. Methods We conducted in‐depth, one‐on‐one telephone interviews with people with diabetes and their caregivers in the United States. The interviews included questions around general awareness of glucagon, reasons for owning or not owning glucagon, and suggestions for improving understanding of glucagon as treatment for severe hypoglycaemia. Initial synopsis and inductive codebook schema were used to analyse the responses by two independent researchers. Themes were developed from the codes, and codes were re‐mapped back to the themes. Results There were 60 dyads of people with diabetes and their caregivers (N = 120). Four themes developed from the interviews: (1) for most participants, the stated reasons for not owning or renewing a prescription for glucagon included unawareness of the medication, its advantages and its value; (2) misperceptions about glucagon occurred frequently; (3) caregivers often lacked confidence in administering reconstituted injectable glucagon; and (4) education and training from healthcare providers about glucagon would be welcomed. Conclusions This study emphasizes the need for healthcare providers to discuss hypoglycaemia prevention and events at each clinical visit, including the use of glucagon in the case of severe hypoglycaemia. Healthcare providers are encouraged to assess the knowledge of people with diabetes and their caregivers regarding treatment and prevention of hypoglycaemia.

show abstract

The multinational onversations and eactions round evere ypoglycemia (CRASH) study: Impact of health care provider communications and recommendations on people with diabetes

Cited by 3 publications

References 6 publications

Severe (level 3) hypoglycaemia occurrence in a real‐world cohort of adults with type 1 or 2 diabetes mellitus (iNPHORM, United States)

Severe (level 3) hypoglycaemia occurrence in a real‐world cohort of adults with type 1 or 2 diabetes mellitus (iNPHORM, United States)

Nasal Glucagon Reverses Insulin-induced Hypoglycemia With Less Rebound Hyperglycemia: Pooled Analysis of Clinical Trials

‘Didn't See the Need’: Misperceptions about glucagon from the perspectives of people with diabetes and their caregivers

Contact Info

Product

Resources

About