Comparison of Intranasal and Injectable Glucagon Administration among Pediatric Population Responders.

Abstract

Ease of use and acceptability of nasal vs injectable glucagon among pediatric responders has been little investigated. This study compared the performance of administering nasal and injectable glucagon in parents of youth with type 1 diabetes and in school workers. Enablers and barriers associated with each glucagon and preferred glucagon administration learning modality were also evaluated. Three months after watching short pedagogical videos, 30 parents and 30 school workers performed simulated scenarios where they administered both glucagon. Completion time and successful execution of critical steps were collected. Interviews assessed preferred learning modalities, barriers, and enablers associated with each glucagon. Both groups administered nasal glucagon faster than injectable glucagon [median (interquartile range): parents 19(12-29) vs 97(71-117) seconds, p<0.001; school workers 24(16-33) vs 129(105-165) seconds, p<0.001]. A lower proportion of participants successfully executed all critical steps for injectable vs nasal glucagon [significant difference for school workers (53% vs 90%; p=0.007) but not for parents (68% vs 83%; p=0.227)]. Nasal glucagon was preferred for ease of use and acceptability. Preferred learning modalities were a combination of videos and workshops, but videos alone could suffice for nasal glucagon. Nasal glucagon is faster to use, more likely to be successfully administered, and more acceptable than injectable glucagon for parents of children with type 1 diabetes and school workers. Nasal glucagon training with videos could improve school workers' involvement in severe hypoglycemia management.