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01 The effects of a leaflet-based intervention, ‘hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services: a non-randomised stepped wedge study
  1. Vanessa Botan1,
  2. Graham R Law1,
  3. Despina Laparidou1,
  4. Elise Rowan1,
  5. Murray D Smith1,
  6. Colin Ridyard1,
  7. Amanda Brewster2,
  8. Robert Spaight3,
  9. Keith Spurr2,
  10. Pauline Mountain2,
  11. Sally Dunmore3,
  12. June James4,
  13. Leon Roberts3,
  14. Kamlesh Khunti5,
  15. Aloysius Niroshan Siriwardena1,3
  1. 1Community and Health Research Unit (CaHRU), School of Health and Social Care, University of Lincoln, UK
  2. 2Patient and Public Contributor, UK
  3. 3East Midlands Ambulance Service (EMAS), UK
  4. 4University Hospitals of Leicester NHS Trust, UK
  5. 5University of Leicester, Leicester, UK


Background Hypoglycaemia is a common complication of diabetes therapy needing prompt recognition and treatment. It often results in ambulance attendance incurring health services costs and patient morbidity. Patient education is important for maintaining glycaemic control and preventing recurrent hypoglycaemia. We aimed to investigate the effect of an intervention in which ambulance staff were trained to provide advice supported by a booklet – ‘Hypos can strike twice’- issued following a hypoglycaemic event to prevent future attendances.

Methods We used a non-randomised stepped wedge-controlled design. The intervention was introduced at different times (steps) in different areas (clusters) of operation of East Midlands Ambulance Service NHS Trust (EMAS). During the first step (T0) no clusters were exposed to the intervention and during the last step (T3) all clusters were exposed. The main outcome was the number of unsuccessful ambulance attendances (i.e. attendances followed by a repeat attendance). Data were analysed using a general linear mixed model (GLMM) and an interrupted-time series analysis (ITSA).

Results The study included 4825 patients (mean age= 65.42, SD=19.42; 2166 females) experiencing hypoglycaemic events attended by EMAS. GLMM indicated a reduction in the number of unsuccessful attendances in the final step of the intervention when compared to the first (OR: 0.50, 95%CI: 0.33-0.76, p=0.001). ITSA indicated a significant decrease in repeat ambulance attendances for hypoglycaemia – relative to the pre-intervention trend (p=0.008). The hypoglycaemia care bundle (i.e. blood glucose recorded before and after treatment for hypoglycaemia) was delivered in 66% of attendances during the intervention period, demonstrating a significant level of practice change (χ2=30.16, p<0.001).

Conclusions The ‘Hypos can strike twice’ intervention had a positive effect on reducing numbers of repeat attendances for hypoglycaemia and in achieving the care bundle. The study supports the use of informative booklets by ambulance clinicians to prevent future attendances for recurrent hypoglycaemic events.

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