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This week, we are excited to present three posters at ADCES Annual Conference. These posters focus on different aspects of severe hypoglycemia, particularly glucagon usage, being prepared for an emergency, and the emotional impacts of low blood glucose events.
Check out the summaries of all three posters below!
Experiences of Caregivers of Children and Young Adults with Type 1 Diabetes Related to Severe Hypoglycemia and Being Prepared with Nasal Glucagon – A Qualitative Study
The mental and emotional well-being of caregivers of children with T1D is becoming increasingly important but is not well-understood.
This study aimed to understand caregiver experiences, including psychological distress, well-being, and social function regarding their child’s risk for severe hypoglycemia and preparedness to handle severe low blood glucose levels. We also wanted to assess the impact of nasal glucagon on these concerns.
Through interviews with caregivers of children with T1D, we saw a theme of vigilant efforts to prevent severe low blood glucose levels. Participants described the diabetes “daily grind” and how much of their day and night was dedicated to their child’s diabetes management.
Sleep disruption was a prominent theme with over half of participants stating that they experienced interrupted sleep due to preventing and treating lows, as well as worrying about the possibility of low blood glucose levels.
Caregivers also described how caring for their child’s diabetes and preventing severe hypoglycemia impacted other areas of their lives, often causing social relationships to be strained, social inhibition, and impeding their work lives.
Many caregivers explained that nasal glucagon increased their confidence in their own ability and other people’s abilities to treat severe hypoglycemia, anticipating that it would be easier to use.
Severe Hypoglycemia Rescue Drugs: Perspectives of People with Diabetes and Emergency Glucagon Usage
To date, aside from fear and embarrassment, the dimensions of fear of hypoglycemia in people with T1D are understudied. The goal of this study was to understand the emotional impact of severe low blood glucose events, time to recovery, and current perceptions of emergency glucagon use.
Through 7 focus groups, participants indicated a high level of stress, worry and concern around severe low blood glucose events. Many participants shared a wide range of emotions about severe hypoglycemia including fear, anxiety, frustration, shame, and embarrassment.
The majority of participants expressed how technology positively impacted their emotions regarding severe hypoglycemia and their fears of hypoglycemia, particularly CGM use. The groups also described overnight hypoglycemia and CGM alarms as important, however some participants also viewed them as sleep disruptors for themselves and their partners.
There were many participants who thought glucagon was not practical due to living alone, never having to use glucagon, and the cost. These focus groups noted that prescription cost and insurance deductibles are some of the biggest barriers to glucagon use.
Many people in the focus groups were also concerned about how difficult it can be to prepare glucagon in an emergency. An easy to administer glucagon is very important, as severe hypoglycemic events can be stressful for all involved.
Perspectives of People with Diabetes on Emergency Glucagon Usage: An Observational Survey from the T1D Exchange Registry
This survey was created for the broader T1D community based on the findings from the focus groups in the above study. This survey focused on the experience of a person with T1D relating to severe hypoglycemia, type of glucagon administration method (nasal versus injection) and the intricacies of choosing a rescue drug.
A total of 73.4% of survey respondents reported that they currently have a glucagon prescription filled, with 61.5% of those having multiple glucagon kits. Within the group who have glucagon on hand, 50.9% had the intramuscular kit, 26.4% had nasal glucagon, 21.5% had Xeris Gvoke glucagon and 9.4% had the GlucaGen HypoPen.
While most participants had a current glucagon prescription, a little over one-fourth did not. Even though almost every participant had experienced a severe hypoglycemic event in their lifetime, glucagon was still underutilized.
The top three most common reasons why survey respondents did not own glucagon were because their doctors had never discussed it, because of their CGM low alerts and because they carry other supplies.
Many participants reported that they were more likely to get glucagon if it was easy to use in the form of a “ready-to-use” treatment such as nasal glucagon or an autoinjector. This survey also highlighted the need for more education about glucagon from healthcare professionals, with a total of 83% of participants reporting that their healthcare providers taught them how to use glucagon.
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