Abstract
BackgroundHypoglycemia unawareness (HU) has been attributed to both a downward shift in central nervous system (CNS)-triggered sympatho-adrenal responses to low glycaemic thresholds and a subsequent loss of adrenergic symptoms, which, in addition, to cerebral cortex adaptations permit normal function under hypoglycaemic conditions. Both of these mechanisms are brought about by recurring hypoglycemic events (hypoglycemia-associate autonomic failure, HAAF). This can contribute to repetitive cycles of increasingly severe hypoglycaemia, the consequences of which have considerable impact on relatives and significant others (SO) when providing care to patients with diabetes. MethodsA Systematic Review (SR) of 639 qualitative studies was carried out in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. The search strategy was developed using MeSH terms for a range of electronic databases: CINAHL, Pubmed, EMBASE, Medline, AMED and ASSIA were systematically searched in order to identify a variety of literature relevant to the review topic. Four duplicate studies were removed and a further 630 studies were excluded due to being irrelevant. Five qualitative studies were retained and analysed. ResultsThe three resultant findings from the literature appraised were i) Experiences and views of Significant Others' (SO) with adult relatives that have HU ii) Support needs of SO and iii) Health professionals interventions to address SO support needs and improve overall HU care. A clear finding was that SO experience difficulties managing HU and this can impact on the relationships that SO and HU patients have. Support needs of SO highlighted were both educational and psychological in nature, with there being a requirement for additional raised awareness within the wider community. ConclusionIt is essential that healthcare professionals offer support, such as teaching and support groups. In addition, providing interventions into improving family knowledge of diabetes and support with regard to psychosocial, behavioural and practical support for the person with diabetes. Moreover, improving resources for families to improve diabetes care. However, as the literature was of a qualitative nature, future recommendations would be quantitative research into these suggested nursing implementations to quantitatively assess their usefulness in practice.
Highlights
The introduction of insulin therapy in 1922 (Banting and Best, 2007) dramatically transformed the prognosis of the previously fatal type 1 diabetes mellitus (T1DM) (Nathan, 2014)
Titles and abstracts of these 21 papers were read against the inclusion/exclusion criteria. 5 papers (Table 2) were required to be read in full as it was unclear from their titles and abstracts alone whether they were relevant
Three main emergent themes were obtained as a result of Significant Others caring for Diabetes Patient’s with Hypoglycemia unawareness (HU): Theme One: Experiences and views of significant others (SO) with adult relatives that have HU; Theme Two: Support needs of SO and Theme Three: Health professionals interventions to address SO support needs and improve overall HU care
Summary
The introduction of insulin therapy in 1922 (Banting and Best, 2007) dramatically transformed the prognosis of the previously fatal T1DM (Nathan, 2014). There are many factors that affect the onset of the diabetes complication HU: i) multiple exposure to hypoglycaemic episodes, ii) individuals with a longer duration of diabetes and iii) insulin therapy (Martin-Timon et al, 2015; White, 2007). Hypoglycemia unawareness (HU) has been attributed to both a downward shift in central nervous system (CNS)-triggered sympatho-adrenal responses to low glycaemic thresholds and a subsequent loss of adrenergic symptoms, which, in addition, to cerebral cortex adaptations permit normal function under hypoglycaemic conditions. Both of these mechanisms are brought about by recurring hypoglycemic events (hypoglycemia-associate autonomic failure, HAAF).
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