Risk of 12-month mortality following a severe inpatient hypoglycaemic event: A single centre retrospective study from the North-West of England

Aims: At our Trust, all severe inpatient hypoglycaemic episodes in individuals with diabetes (defined as a hypoglycaemic episode requiring injectable treatment) are reported to NaDIA-Harms (National Diabetes Inpatient Audit). We conducted a detailed review of the care of all these events to improve patient safety. In this study, we assessed the risk of 12-month mortality following an episode of severe inpatient hypoglycaemia. Method(s): Reportable NaDIA harms of patients admitted during the period 2018-2022 were recorded into a dataset. Applicable patient records were reviewed at 12 months following the event to see how many patients were deceased and details of comorbidities at the time of the severe hypoglycaemic episode were collected. Result(s): To date, of 107 inpatients who experienced a severe hypoglycaemic episode 55% were deceased within 12 months. In patients admitted during the peak of the Covid-19 pandemic recorded as year April 2020/March 2021, 80% of patients who had a NaDIA hypoglycaemic event died within 12 months. Conclusion(s): Mortality rate following an episode of inpatient hypoglycaemia appears to be several-fold higher than previous reported rates of 4.45%-22.1% for community-dwelling individuals who experience a severe hypoglycaemic event. This maybe partially explained by the increased frailty, polypharmacy and multimorbidity among this cohort, but there is evidence linking hypoglycaemia with cardiovascular mortality. Although no causality between severe inpatient hypoglycaemia and death can be inferred from this study because of the observational nature, it does highlight the importance preventing inpatient episodes of hypoglycaemia through effective monitoring and proactive treatment modification.

Digital diabetes care: How well equipped are patients and what do they think about it

Aims: Covid-19 precipitated an abrupt shift to non-face- to- face (digital) consultation. Some believe that this was overdue and that digital is better for many patients. Our aim was to establish the extent to which people with diabetes were equipped to manage digital consultation and what they felt about it. Methods: We surveyed 1,000 people with diabetes (500 type 1, 500 type 2) from our local, largely deprived community with a user-approved questionnaire, tested for face validity and readability. Results: Response rate was 376/1000 (38%);132 (35%) type 1 diabetes, 218 (58%) type 2 diabetes, 1% other and 6% blank. Age of respondents was: ≤30, 0%;31-40, 4%;41-50, 7%;51-60, 12%;61-70, 17%;71-80, 52%;81-90, 3%;and blank, 5%. Treatment was: diet alone, 11%;diet and tablets, 39%;diet and insulin injections, 24%;diet, tablets and glucagon-like peptide-1 receptor agonist, 2%;insulin pump, 9%;and blank, 6%. Some 22% were attending the hospital clinic;74% not and 4% blank. Only 40% patients had access to a video calling device and only 35% had ever used it. Separate Likert scales showed: 79% strongly preferred or preferred face-to- face consultation, 17% strongly preferred or preferred telephone;and only 6% strongly preferred or preferred video consultation;66% recognised limitations in examination, weight and blood pressure checks with digital. Summary: Our survey, representative of type 1 and type 2 diabetes and of all treatment modalities but with underrepresentation of very young respondents, reveals that most patients did not have equipment for digital consultation and 79% preferred face-to- face consultation.

Covid-19 pandemic associated with three-fold increase in demand for diabetes specialist advice

Aims: The covid-19 pandemic was associated with legally restricted public movement (lockdowns) and reduced access to face-to- face consultation for diabetes in primary and specialist care. The aim of this study was to assess the impact of the pandemic on requests for specialist telephone support. Methods: Retrospective analysis of calls for telephone support before and during the covid-19 pandemic via three separate extensions tailored to specific needs: (1) diabetes emergency advice line (direct diabetes specialist emergency advice 08.00-20.00, Monday to Friday and 08.00-16.00 Saturday and Sunday);(2) diabetes general advice line (a 24/7 telephone answer machine, typically used by patients and carers, answered repeatedly Monday to Friday 08.00-18.00);and (3) a diabetes community line, typically used by healthcare professionals in the community. We arbitrarily defined 'pre-covid' as calls up to 31/3/20 and 'during covid' as calls thereafter to 1/5/21. Results: Mean ( ± SD) calls per calendar month (pcm) increased highly significantly: 81 ( ± 80) pcm pre-covid to 248 ( ± 72) pcm during covid, p < 0.001. Emergency advice line calls did not increase: 15 ( ± 5) pcm pre-covid to 18 ( ± 11) during covid, p = 0.9, general advice line calls increased non-significantly: 161 ( ± 19) to 194 ( ± 68), p = 0.1, but community calls increased highly significantly: 16 ( ± 6) to 36 ( ± 12), p < 0.001. Although calls rose during lockdowns, the monthly picture was more of a sustained increase after the first lockdown. Summary: The covid-19 pandemic has been associated with a sustained increase in requests for non-emergency diabetes specialist team advice, particularly from primary care professionals in the community.

Implementation of a home monitoring system for COPD patients during the SARS-CoV-2 pandemic: A feasibility study

RATIONALE: Remote monitoring of COPD patients has the potential to improve clinical outcomes. The ability to successfully deploy home monitoring technologies to COPD patients remotely without in-person encounters is of particular interest during the SARS-CoV-2 pandemic. We present interim results from a prospective implementation study of a home monitoring system in COPD patients at-risk for frequent acute exacerbations of COPD (AECOPD). METHODS: We recruited non-hospitalized individuals aged 40-80 years with spirometryconfirmed COPD and increased AECOPD risk (one hospitalization or two outpatient AECOPD in the prior year). The home system includes: a GoHome™ Data Collection Platform and GoSpiro® spirometer (Monitored Therapeutics, Dublin, OH), and a 3230 pulse oximeter (Nonin Medical, Plymouth, MN). The tablet-based GoHome™ has an auto-start system requiring no computer skills for operation. Eligible participants were contacted via phone, and if interested, were sent a participation kit containing informed consent and the home system. After remotely collecting ICF, participants completed device setup and baseline spirometry using Avatar coaching. At set times, the device collects responses for an automated COPD Action Plan and displays reminders for the patient to use the integrated Bluetooth® spirometer and pulse oximeter. The GoSpiro® measures slow vital capacity (SVC) and forced vital capacity (FVC) using an Avatar-assisted technology coach on the GoHome™ (Figure). The Avatar coaches the patient through each measurement following ATS recommendations for instructions and coaching, followed by error identification and maneuver error correction without human intervention. Patients are engaged daily with the COPD Action Plan. Automated scores return immediate patient guidance along with appropriate clinician alerts. Results are cellular or Wi-Fi uploaded to a cloud server for realtime investigator review. Following demonstrated proficiency, daily measurements of spirometry (FVC Tuesday/Thursday, SVC all other days), daily pulse oximetry and COPD Action Plan were performed. Participant study duration was three months. RESULTS: To date, seven of 12 planned participants have been enrolled. All enrolled participants have successfully activated all device components and performed FVC maneuvers meeting ATS acceptability standards. All participants were able to complete collection and transmission of daily pulse oximetry and COPD Action Plan data. One participant requested study withdrawal after three weeks and six participants remain on study. CONCLUSIONS: Deployment of a COPD home telemonitoring system platform including daily spirometry, pulse oximetry and electronic questionnaire without in-person contact is feasible. This technology may be useful in settings where in-person visits are not feasible due to patient safety, remote location or access-related issues. .