Developing an understanding of brief intervention opportunities to support people in emergency care settings, in order to prevent subsequent severe hypoglycaemic events

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: Severe hypoglycaemic events (SHEs) are classified as glucose readings of 3.9mmol/l and below, requiring assistance from another person to treat. These diabetic emergencies often require emergency services attendance and are associated with lower general health, greater fear and anxiety, lower health-related quality-of-life, higher risk of long term complications, higher risk of mortality, reduced work productivity, and problems performing daily activities. Patient empowerment and structured patient education programs aimed at reducing SHEs and restoring hypoglycaemia awareness are highly recommended. However, there seems to be a paucity of evidence surrounding the understanding of SHEs and their aftermath for affected people and family members involved. This lack of current evidence compromises the incorporation of timely, person-centred interventions within the SHE treatment pathway once an event has occurred. Promising approaches for emergency services teams to support post-event daily self-management activities are brief interventions (Bls). Therefore, this study’s overall aim was to understand BI opportunities within emergency service settings to inform SHE-related care.

Method: The overall aim was addressed by three distinct but linked studies. In the first step, an analysis of routinely collected data over a 12-month period (paper 1) quantified and described the characteristics of individuals treated for SHEs in a single emergency care setting in Switzerland. A systematic review study (paper 2) identified BI components and outcomes for people with diabetes in a second step. Finally, a constructivist grounded theory study explored patterns of social actions, interactions, and behaviour in twelve affected persons and six spouses who were experiencing and responding to SHEs and dealing with their aftermath.

Results: Paper 1 showed that over 50% of those affected by SHEs were men over 65 years, living in a relationship, and diagnosed with type 2 diabetes for over a decade. Individuals treated by emergency medical services alone were significantly younger than those subsequently treated in the emergency department or requiring follow-up inpatient treatment. Paper 2 demonstrated inconsistency in the use of the term BI and a lack of evidence of Bls for people with diabetes in emergency care and other care settings. In the four studies included in the systematic literature review, psychological, functional and satisfactory patient outcomes were significantly improved, whereas clinical outcomes were not. Reported core BI components utilised included assessment, advice-giving and assistance. The emerged explanatory theory described the affected person’s and their spouse’s individual and shared experiences and interactions while responding to SHEs. Four phases constituted a chronological trajectory while experiencing a disturbed rhythm of activities: a) falling out of rhythm, b) re-establishing identity, c) re-establishing routines, and d) experiencing (new) normality. These results combined led to three key findings providing novel insights and aspects in the care of people with SHEs and opportunities for BI: 1) SHEs led to a disrupted self, identity and normality in affected people, 2) the need for effective individual and couples interventions to strengthen ongoing management to prevent future SHEs and 3) identified windows of opportunity for Bls during the encounter with emergency care services and beyond.

Conclusion: The findings highlighted the disruptive nature of SHEs in affected people and their spouses’ lives. During the encounter with emergency care services, there is an opportunity for Bls to initiate ongoing support with the core components of assessment, advice-giving and assistance. Therefore, Bls need to be integrated into person-centred clinical pathways in emergency care services. Further, essential ongoing support throughout the mentioned trajectory calls for trusting relationships between healthcare professionals and affected persons and spouses. Lastly, it is crucial to raise awareness of the issue among healthcare professionals and provide appropriate training.
Date of Award1 Feb 2022
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJackie Sturt (Supervisor), Gerry Lee (Supervisor) & Lorenz Imhof (Supervisor)

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