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Not only for caregivers: intranasal glucagon for severe hypoglycaemia in a simulation study

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Abstract

Aims

To evaluate: (i) the propensity of paediatrics and emergency medicine residents to select different therapeutic options and (ii) the speed and administration success in a high-fidelity simulation of severe hypoglycaemia in a child with type 1 diabetes (T1DM).

Methods

In this single-centre high-fidelity simulation study, 51 paediatrics or emergency medicine residents were exposed to a scenario of severe hypoglycaemia in a T1DM child attending an ambulatory setting, before and after a training on the preparation and administration of both injectable and IN glucagon. Time for drug delivery and its effectiveness were collected.

Results

Before training, 45.1% of participants chose to administer injectable glucagon, 43.1% intravenous glucose solution, 5.9% intranasal (IN) glucagon, and 5.9% took no action. Administration was successful in 74% of injectable glucagon, 33.3% intravenous glucose solution, and 22.7% IN glucagon. After training, 58.8% of participants chose IN and 41.2% injectable glucagon, with 100% of successful administrations for IN glucagon and 90.5% for injectable glucagon. Time to successful administration was shorter for IN than injectable glucagon (23 ± 10 vs. 38 ± 7 s, p < 0.0001).

Conclusions

IN glucagon is an easy and effective option for severe hypoglycaemia treatment, with an almost zero possibility of failure provided that adequate training is imparted.

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Data availability

The data that support the findings of this study are available from the corresponding author, IR, upon reasonable request.

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Acknowledgements

The authors would like to thank all the residents who took part to this simulation study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy

    A. Monzani, S. Savastio, A. Manzo, E. Pozzi & I. Rabbone

  2. SIMNOVA Interdepartmental Centre for Innovative Learning and Simulation in Medicine and Allied Health Professions, University of Piemonte Orientale, via Lanino 1, 28100, Novara, Italy

    A. Scalogna & F. Della Corte

  3. Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy

    PP. Sainaghi & F. Della Corte

Authors
  1. A. Monzani
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  2. S. Savastio
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  3. A. Manzo
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  4. A. Scalogna
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  5. E. Pozzi
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  6. PP. Sainaghi
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  7. F. Della Corte
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  8. I. Rabbone
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Alice Monzani, Silvia Savastio, Andrea Manzo, Antonio Scalogna, Erica Pozzi, and Ivana Rabbone. The first draft of the manuscript was written by Alice Monzani and Ivana Rabbone, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to I. Rabbone.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This is a simulation study. The Ethics Committee of University of Piemonte Orientale (Novara, Italy) has confirmed that no ethical approval is required.

Informed consent

All subjects provided written informed consent to participate to the simulation study and to the tape-recording of scenarios.

Additional information

Managed By Antonio Secchi.

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Monzani, A., Savastio, S., Manzo, A. et al. Not only for caregivers: intranasal glucagon for severe hypoglycaemia in a simulation study. Acta Diabetol 59, 1479–1484 (2022). https://doi.org/10.1007/s00592-022-01952-6

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  • DOI: https://doi.org/10.1007/s00592-022-01952-6

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