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Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes

BACKGROUND: Hospital admissions for severe hypoglycemia are associated with significant healthcare costs, decreased quality of life, and increased morbidity and mortality, especially for older adults with diabetes. Understanding the reasons for hypoglycemia hospitalization is essential for the devel...

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Autores principales: Pasciak, Weronika E., Berg, David N., Cherlin, Emily, Fried, Terri, Lipska, Kasia J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130109/
https://www.ncbi.nlm.nih.gov/pubmed/34001014
http://dx.doi.org/10.1186/s12877-021-02268-w
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author Pasciak, Weronika E.
Berg, David N.
Cherlin, Emily
Fried, Terri
Lipska, Kasia J.
author_facet Pasciak, Weronika E.
Berg, David N.
Cherlin, Emily
Fried, Terri
Lipska, Kasia J.
author_sort Pasciak, Weronika E.
collection PubMed
description BACKGROUND: Hospital admissions for severe hypoglycemia are associated with significant healthcare costs, decreased quality of life, and increased morbidity and mortality, especially for older adults with diabetes. Understanding the reasons for hypoglycemia hospitalization is essential for the development of effective interventions; yet, the causes and precipitants of hypoglycemia are not well understood. METHODS: We conducted a qualitative study of non-nursing home patients aged 65 years or older without cognitive dysfunction admitted to a single tertiary-referral hospital with diabetes-related hypoglycemia. During the hospitalization, we conducted one-on-one, in-depth, semi-structured interviews to explore: (1) experiences with diabetes management among patients hospitalized for severe hypoglycemia; and (2) factors contributing and leading to the hypoglycemic event. Major themes and sub-themes were extracted using the constant comparative method by 3 study authors. RESULTS: Among the 17 participants interviewed, the mean age was 78.9 years of age, 76.5% were female, 64.7% African American, 64.7% on insulin, and patients had an average of 13 chronic conditions. Patients reported: (1) surprise at hypoglycemia despite living with diabetes for many years; (2) adequate support, knowledge, and preparedness for hypoglycemia; (3) challenges balancing a diet that minimizes hyperglycemia and prevents hypoglycemia; (4) the belief that hyperglycemia necessitates medical intervention, but hypoglycemia does not; and (5) tension between clinician-prescribed treatment plans and self-management based on patients’ experience. Notably, participants did not report the previously cited reasons for hypoglycemia, such as food insecurity, lack of support or knowledge, or treatment errors. CONCLUSIONS: Our findings suggest that some hypoglycemic events may not be preventable, but in order to reduce the risk of hypoglycemia in older individuals at risk: (1) healthcare systems need to shift from their general emphasis on the avoidance of hyperglycemia towards the prevention of hypoglycemia; and (2) clinicians and patients need to work together to design treatment regimens that fit within patient capacity and are flexible enough to accommodate life’s demands. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-021-02268-w.
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spelling pubmed-81301092021-05-18 Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes Pasciak, Weronika E. Berg, David N. Cherlin, Emily Fried, Terri Lipska, Kasia J. BMC Geriatr Research Article BACKGROUND: Hospital admissions for severe hypoglycemia are associated with significant healthcare costs, decreased quality of life, and increased morbidity and mortality, especially for older adults with diabetes. Understanding the reasons for hypoglycemia hospitalization is essential for the development of effective interventions; yet, the causes and precipitants of hypoglycemia are not well understood. METHODS: We conducted a qualitative study of non-nursing home patients aged 65 years or older without cognitive dysfunction admitted to a single tertiary-referral hospital with diabetes-related hypoglycemia. During the hospitalization, we conducted one-on-one, in-depth, semi-structured interviews to explore: (1) experiences with diabetes management among patients hospitalized for severe hypoglycemia; and (2) factors contributing and leading to the hypoglycemic event. Major themes and sub-themes were extracted using the constant comparative method by 3 study authors. RESULTS: Among the 17 participants interviewed, the mean age was 78.9 years of age, 76.5% were female, 64.7% African American, 64.7% on insulin, and patients had an average of 13 chronic conditions. Patients reported: (1) surprise at hypoglycemia despite living with diabetes for many years; (2) adequate support, knowledge, and preparedness for hypoglycemia; (3) challenges balancing a diet that minimizes hyperglycemia and prevents hypoglycemia; (4) the belief that hyperglycemia necessitates medical intervention, but hypoglycemia does not; and (5) tension between clinician-prescribed treatment plans and self-management based on patients’ experience. Notably, participants did not report the previously cited reasons for hypoglycemia, such as food insecurity, lack of support or knowledge, or treatment errors. CONCLUSIONS: Our findings suggest that some hypoglycemic events may not be preventable, but in order to reduce the risk of hypoglycemia in older individuals at risk: (1) healthcare systems need to shift from their general emphasis on the avoidance of hyperglycemia towards the prevention of hypoglycemia; and (2) clinicians and patients need to work together to design treatment regimens that fit within patient capacity and are flexible enough to accommodate life’s demands. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-021-02268-w. BioMed Central 2021-05-17 /pmc/articles/PMC8130109/ /pubmed/34001014 http://dx.doi.org/10.1186/s12877-021-02268-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Pasciak, Weronika E.
Berg, David N.
Cherlin, Emily
Fried, Terri
Lipska, Kasia J.
Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes
title Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes
title_full Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes
title_fullStr Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes
title_full_unstemmed Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes
title_short Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes
title_sort qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130109/
https://www.ncbi.nlm.nih.gov/pubmed/34001014
http://dx.doi.org/10.1186/s12877-021-02268-w
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