Following successful use of IM glucagon for hypoglycaemia can patients be left at home
Date First Published:
July 7, 2003
Last Updated:
September 5, 2003
Report by:
Eleanor Thomas, Paramedic (Mersey Regional Ambulance Service NHS Trust)
Search checked by:
tbc, Mersey Regional Ambulance Service NHS Trust
Three-Part Question:
Are [recovered diabetic patients] who have been treated with [IM glucagon for hypoglycaemia by paramedic staff] [safe to be left at home]?
Clinical Scenario:
Following a 999 call to their home, an adult insulin-dependent diabetic patient is successfully treated with IM glucagon for hypoglycaemia by the attending ambulance crew. The patient is now fully recovered, they feel fine and their blood glucose level is above 5mmol/l. The patient does not want to go to hospital so is it safe to leave them at home?
Search Strategy:
Medline 1966-07/03 using the PubMed interface.
Search Details:
(diabet*OR diabetic* OR hypoglc*) AND (glucag*OR treatment*OR treatment refusal) AND (paramedic OR ambulance OR emergenc* OR prehosp* OR pre-hosp*) LIMIT to human AND English
Outcome:
202 papers found but, as Roberts and Smith carried out a comprehensive literature review in July 2001 (1,4), only included relevant papers published after this date. See reference section for additional papers deemed to be relevant but already included in the Smith and Roberts review.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Outcome of diabetic patients treated in the prehospital arena after a hypoglycaemic episode, and an exploration of treat and release protocols: a review of the literature. Roberts K, Smith A. 2003, UK | Patients treated for hypoglycaemia in pre-hospital environment | Literature review | Safety of treat & release practice | Based on evidence found safe for 90% patients. Produced set of recommend-ations for patients who should be transported which includes patients treated with IM glucagon as risk of relapse. | Outdated literature, need for RCT |
| Can paramedics safely treat and discharge hypoglycaemic patients in the field? Lerner E B, Billittier A J 4th, Lance D R et al. 2003, USA | 36 insulin dependent diabetics treated for hypoglycaemia with IV glucose and left at home | Prospective, observational study | Complications 24 hours after treatment | 91% no complications, 2 patients had recurrent hypos but treated themselves. 100% of patients in survey favoured protocol allowing them to be left at home | Inclusion & excusion criteria not followed consistently Not all patients received same treatment eg 50% glucose, 10% glucose, food and only I patient received glucagon |
| Transport refusal by hypoglycaemic patients after on-scene intravenous dextrose. Carter AJ, Keane PS, Dreyer JF. 2002, Canada | 100 patients treated with IV dextrose for hypoglycaemia | Telephone survey | Seeking medical treatment in the 3 days following treatment | 68% refused transport - average age 47.Transported patients average age 64.7. No difference in repeat access to health care and in both groups satisfaction was high | Does not specify what repeat medical treatment was sought |
| Appropriateness of leaving emergency medical service treated hypoglycemic patients at home: a retrospective study. Anderson S, Hogskilde P D, Wetterslev J et al. 2002, Denmark | 1148 hypoglycaemic patients – 87% treated with IV glucose, 2% with IM glucagon | Retrospective study | 72 hour follow-up | 968 (84%) patients left at home – 862 of which no secondary contact. | MICU in Denmark staffed by doctors – not directly comparable with UK |
| Prehospital management of diabetes. Murphy P, Colwell C. 2002, USA | Awaiting paper |
Author Commentary:
There appears to be an increasing body of evidence to suggest that in the majority of cases it is safe to leave recovered hypoglycaemic patients at home. However there is very little specific evidence relating to treatment with IM glucagon as the vast majority of patients in these studies have been treated with IV glucose.
Bottom Line:
There is little evidence to show that it is safe to leave patients who have been treated with IM glucagon for hypoglycaemia at home. This is an area that urgently requires more research so that standardised treat and release protocols can be established and implemented in the pre-hospital environment.
References:
- Roberts K, Smith A.. Outcome of diabetic patients treated in the prehospital arena after a hypoglycaemic episode, and an exploration of treat and release protocols: a review of the literature.
- Roberts K and Smith A.. The Pre-hospital management of hypoglycaemia: a review of the literature. Report for The Wales Office of Research and Development for Health and Social Care
- Lerner E B, Billittier A J 4th, Lance D R et al.. Can paramedics safely treat and discharge hypoglycaemic patients in the field?
- Carter AJ, Keane PS, Dreyer JF.. Transport refusal by hypoglycaemic patients after on-scene intravenous dextrose.
- Anderson S, Hogskilde P D, Wetterslev J et al.. Appropriateness of leaving emergency medical service treated hypoglycemic patients at home: a retrospective study.
- Murphy P, Colwell C.. Prehospital management of diabetes.