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

项目总结/摘要 糖尿病管理中的严重低血糖与高发病率、死亡率、心理健康和糖尿病并发症有关。 生活质量（QoL）受损。作为高风险患者，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患者，通常无法识别; 低血糖症是广泛的，跨越临床和非临床领域;糖尿病管理往往不 尽管风险很高但还是改变了认识，积极参与，并提供全面的护理，以风险 患者解决低血糖风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，减轻糖尿病痛苦，并改善QoL。 社区护理人员（CP）接受疾病预防，管理和健康方面的培训， 应急处置他们具有独特的定位，提供全面的以病人为中心的护理， 特别是对于临床和心理社会复杂的患者。他们可以让病人在家里， 临床和非临床需求，提供教育，并从事医疗和社会支持服务。我们的团队 已经证明，对既往医疗保健利用率高的患者进行CP干预可以减少 在6个月的时间内，急诊科（艾德）就诊率和住院率分别下降了25%和56%。 我们假设CP在治疗严重低血糖后进行综合管理， 改善糖尿病自我管理，预防低血糖，减轻糖尿病痛苦，改善生活质量。 本申请的总体目标是评估以下方面的可行性、初步疗效和可接受性： 糖尿病-REM（救援，参与和管理），以改善成人糖尿病自我管理 在明尼苏达州东南部，他因低血糖接受了马约诊所救护车的治疗。CP将收到 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名成人将被随机分配到1个月的糖尿病-REM或常规护理。两组 将收到关于低血糖/糖尿病和临床/社区资源的教育材料。在目标1中，我们 评估糖尿病快速眼动模式在改善糖尿病自我管理（初级）方面的可行性和有效性。 结果），次要结果为低血糖、高血糖、糖尿病痛苦和生活质量，均进行评估 在第1个月（干预结束）和第4个月（效果持久性）。在目标2中，我们将定性地检查 患者对糖尿病快速眼动的感知，关注糖尿病快速眼动的特定组成部分，或者没有， 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麦考伊博士正在进行的临床和 NIDDK K23奖支持的社会人口学低血糖风险因素，并将提供初步的 在R 01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.