Monzani A, Savastio S, Manzo A, Scalogna A, Pozzi E, Sainaghi P P, Della Corte F, Rabbone I
Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy.
SIMNOVA Interdepartmental Centre for Innovative Learning and Simulation in Medicine and Allied Health Professions, University of Piemonte Orientale, via Lanino 1, 28100, Novara, Italy.
Acta Diabetol. 2022 Nov;59(11):1479-1484. doi: 10.1007/s00592-022-01952-6. Epub 2022 Aug 11.
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).
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.
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).
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.
评估：（i）儿科和急诊医学住院医师选择不同治疗方案的倾向，以及（ii）在1型糖尿病（T1DM）儿童严重低血糖的高保真模拟中给药的速度和成功率。
在这项单中心高保真模拟研究中，51名儿科或急诊医学住院医师在接受关于注射用和鼻内用胰高血糖素的配制和给药培训前后，接触了一名在门诊就诊的T1DM儿童严重低血糖的场景。收集给药时间及其有效性数据。
培训前，45.1%的参与者选择注射胰高血糖素，43.1%选择静脉注射葡萄糖溶液，5.9%选择鼻内用胰高血糖素，5.9%未采取行动。注射用胰高血糖素的给药成功率为74%，静脉注射葡萄糖溶液为33.3%，鼻内用胰高血糖素为22.7%。培训后，58.8%的参与者选择鼻内用胰高血糖素，41.2%选择注射用胰高血糖素，鼻内用胰高血糖素的给药成功率为100%，注射用胰高血糖素为90.5%。鼻内用胰高血糖素成功给药的时间比注射用胰高血糖素短（23±10秒对38±7秒，p<0.0001）。
鼻内用胰高血糖素是治疗严重低血糖的一种简便有效的选择，只要给予充分培训，失败的可能性几乎为零。
