Glucagon use in paediatric type 1 diabetic patients : an innovative approach to improve outcomes

Abstract

Hypoglycaemia is the most common acute complication and is considered a major problem amongst children with type 1 diabetes mellitus. Hypoglycaemia is very often undetected, under-reported and poorly understood by the patients and their carers. This lack of confidence in detecting, reporting and understanding hypoglycaemia puts patients at risk of consequences of untreated hypoglycaemia which can range from seizures to premature death. The aim of this research was to develop and evaluate the impact of educating carers of paediatric patients suffering from type 1 diabetes mellitus, on the emergency use of glucagon in hypoglycaemia in a safe and effective way. A Glucagon Tool Kit was developed in both Maltese and English, consisting of information on hypoglyceamia, a chart and a video on how to reconstitute and use glucagon. This was disseminated to all pharmacists and a questionnaire was completed to analyse the knowledge and confidence on the use of glucagon before and after the intervention. The same Glucagon Tool Kit was given to carers of children with type 1 diabetes mellitus. Carers were recruited after their visit to the outpatients’ clinic with the medical consultant. A questionnaire was completed at baseline to assess carers’ knowledge on glucagon. Carers were given the Glucagon Tool Kit and four weeks after intervention, carers were contacted by phone to complete the questionnaire again to reflect the impact of the intervention. The ‘Pharmacist Glucagon Assessment Questionnaire’ was completed by 139 pharmacists. Using the Wilcoxon sign test a significant difference was noted in both confidence and knowledge of use on glucagon when before to after intervention is compared (p < 0.001). One hundred and forty patients with type 1 diabetes mellitus attend the paediatric diabetes outpatients service at Mater Dei Hospital. Of these 80 were successfully interviewed. A statistical significant difference (p < 0.001) was noted when comparing before intervention to after intervention for confidence and knowledge on reconstituting glucagon. The educational material developed had a significant impact on the knowledge and confidence the pharmacist and carers have on the use and reconstitution of glucagon. This will empower pharmacists with better tools to educate patients and to instill confidence in carers to make use of glucagon appropriately when required.