Randomised controlled trial of an innovative hypoglycaemia pathway for self-care at home and admission avoidance: a partnership approach with a regional ambulance trust.

Background: Hypoglycaemia is a common and potentially life-threatening condition in people with diabetes, commonly caused by medications such as insulin. Hypoglycaemic events often require in-patient treatment and/or follow-up with a diabetes specialist nurse (DSN) or GP to make adjustments to medication. This referral pathway commonly relies on patient self-referral to primary care, and as a result many patients are not actively followed up and go on to experience repeat hypoglycaemic events. Methods: Randomised controlled trial in partnership with East Midlands Ambulance Service NHS Trust. People with diabetes calling out an ambulance for a severe hypoglycaemic episode and meeting the eligibility criteria were randomised to either a novel DSN-led pathway or to their general practice for routine follow-up. Primary outcome was proportion of participants with a documented consultation with a healthcare professional to discuss the management of their diabetes within 28 days of call-out. Results: 162 people were randomised to one of the pathways (73 DSN arm, 89 GP arm) with 81 (50%, 35 DSN, 46 GP) providing full consent to be followed up. Due to lower than anticipated randomisation and consent rates, the recruitment target was not met. In the 81 participants who provided full consent, there were higher rates of consultation following the call-out when referred to a DSN compared to primary care (90% vs. 65%). Of the 81 participants, 26 (32%) had a second call-out within 12 months. Conclusions: Consultation rates following the call-out were high in the DSN-led arm, but there was insufficient power to complete the planned comparative analysis. The study highlighted the difficulty in recruitment and delivery of research in pre-hospital emergency care. Further work is needed to provide more feasible study designs and consent procedures balancing demands on ambulance staff time with the need for robust well-designed evaluation of referral pathways.

'I deserve a treat!': justifications for indulgence undermine the translation of intentions into action.

The present research explores how justifications for indulgence influence the translation of 'good' intentions into action. Three studies investigated the nature of such justifications and their relation to indulgence. Study 1 identified six ways that people justify indulgence to themselves - that they are deserving or curious, that the indulgence is an exception to the norm or can be compensated for later, or that the tempting food is available or irresistible. Study 2 showed that the use of justifications undermined participants' strong (but not weak) intentions to halve their consumption of a nominated high-fat food. Study 3 found that priming the use of justifications increased the amount of chocolate that participants consumed in a subsequent, ostensibly unrelated, taste test. Again, justification use had a greater effect on participants with strong intentions to limit indulgence. Taken together, the studies suggest a new approach to understanding intention-behaviour discrepancies.