Community Paramedicine Program to Improve Diabetes Management among Adults Experiencing Severe Hypoglycemia

项目摘要/摘要 糖尿病治疗中的严重低血糖与高发病率、死亡率、心理 痛苦和生活质量受损。作为高危患者，预防低血糖具有挑战性， 包括那些已经经历过严重低血糖的人，通常不被识别； 低血糖是广泛的，跨越临床和非临床领域；而糖尿病的治疗通常不是 尽管风险很高，但还是发生了变化。识别、积极参与并为高危人群提供全面护理 患者解决低血糖危险因素和提高糖尿病自我管理技能可能有助于减少 低血糖事件的频率/严重程度，缓解糖尿病痛苦，改善生活质量。 社区护理人员(CP)除了接受疾病预防、管理和健康方面的培训外 紧急响应。它们在提供以患者为中心的全面护理方面具有独特的优势， 尤其是对临床和心理复杂的患者。他们可以让患者在家中参与，识别 临床和非临床需求，提供教育，并提供医疗和社会支持服务。我们的团队 已经证明，对先前医疗服务利用率较高的患者进行CP干预可以减少 在6个月的时间里，急诊科就诊和住院分别减少了25%和56%。 我们假设，在接受严重低血糖治疗后，CPS的综合治疗将 改善糖尿病自我管理，预防低血糖，减少糖尿病痛苦，改善生活质量。 此应用程序的总体目标是评估以下各项的可行性、初步效果和可接受性 糖尿病-REM(救援、参与和管理)改善成人糖尿病自我管理 在明尼苏达州东南部，他曾接受梅奥诊所救护车的低血糖治疗。CPS将收到 关于糖尿病及其管理的正式培训，将由研究小组制定。使用两组 平行设计，150名成年人将被随机分配到1个月的糖尿病-快速眼动或常规护理。两组均为 将收到关于低血糖/糖尿病的教育材料和临床/社区资源。在目标1中，我们将 评估糖尿病-REM改善糖尿病自我管理(初级)的可行性和有效性 结果)，以及低血糖、高血糖、糖尿病痛苦和生活质量的次要结果，所有这些都被评估 在第1个月(干预结束)和第4个月(为了效果的持久性)。在目标2中，我们将定性地检查 患者对糖尿病的看法-快速眼动，重点是糖尿病-快速眼动的特定组成部分， 满足他们的需求。 这项工作自然建立在我们强大的初步数据和McCoy博士正在进行的临床和 社会人口学低血糖危险因素由NIDDK K23奖支持，并将提供初步 在R01资助的随机对照试验中更广泛地实施和评估糖尿病-REM的数据。

PROJECT SUMMARY/ABSTRACT Severe hypoglycemia in the management of diabetes is associated with high morbidity, mortality, psychological distress, and impaired quality of life (QoL). Preventing hypoglycemia is challenging as high risk patients, including those who have already experienced severe hypoglycemia, are often not identified; risk factors for hypoglycemia are broad, spanning clinical and non-clinical domains; and diabetes management is often not altered despite a high risk profile. Recognizing, actively engaging, and providing comprehensive care to at-risk patients to address hypoglycemia risk factors and enhance diabetes self-management skills may help reduce the frequency/severity of hypoglycemic events, alleviate diabetes distress, and improve QoL. Community paramedics (CPs) are trained in disease prevention, management, and wellness in addition to emergency response. They are uniquely positioned to deliver comprehensive patient-centered care, particularly to clinically and psychosocially complex patients. They can engage patients in their homes, identify clinical and non-clinical needs, provide education, and engage medical and social support services. Our team has demonstrated that CP interventions for patients with high prior healthcare utilization can reduce emergency department (ED) visits and hospitalizations by 25% and 56%, respectively, over a 6-month period. We hypothesize that comprehensive management by CPs after being treated for severe hypoglycemia will improve diabetes self-management, prevent hypoglycemia, reduce diabetes distress, and improve QoL. The overall objective of this application is to assess the feasibility, preliminary efficacy, and acceptability of Diabetes-REM (Rescue, Engagement, and Management) to improve diabetes self-management among adults in southeast Minnesota who had been treated for hypoglycemia by Mayo Clinic Ambulance. CPs will receive formal training on diabetes and its management, which will be developed by the study team. Using a two-group parallel design, 150 adults will be randomly assigned to 1 month of Diabetes-REM or usual care. Both groups will receive education materials on hypoglycemia/diabetes and clinical/community resources. In Aim 1, we will evaluate the feasibility and efficacy of Diabetes-REM in improving diabetes self-management (primary outcome), with secondary outcomes of hypoglycemia, hyperglycemia, diabetes distress, and QoL, all assessed at month 1 (end of intervention) and month 4 (for durability of effect). In Aim 2, we will qualitatively examine patient perceptions of Diabetes-REM, focusing on specific Diabetes-REM components of that did, or did not, meet their needs. This work naturally builds on our robust preliminary data and Dr. McCoy’s ongoing evaluation of clinical and sociodemographic hypoglycemia risk factors supported by a NIDDK K23 Award, and will provide preliminary data for broader implementation and evaluation of Diabetes-REM in a R01-funded randomized controlled trial.