{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T14:46:28Z","timestamp":1792161988606,"version":"4.4.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"5","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R03DK127010"],"award-info":[{"award-number":["R03DK127010"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P30AG097158"],"award-info":[{"award-number":["P30AG097158"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Severe (level 3) hypoglycemia is a life-threatening complication of diabetes associated with substantial risk of recurrence and long-term morbidity. This study examined how adults with diabetes interpreted severe hypoglycemic events and why they declined participation in a community paramedicine program (Diabetes Rescue, Engagement, and Management [Diabetes-REM]) designed to prevent recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We conducted semistructured qualitative interviews with adults with type 1 or type 2 diabetes who experienced severe hypoglycemia requiring emergency medical services and declined enrollment in Diabetes-REM. Interviews explored hypoglycemia management experiences and reasons for nonparticipation and were explored using thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Sixteen adults (44% female; mean age 60 years, range 25\u201383) participated. Four interrelated themes emerged. First, participants normalized glucose variability as a baseline condition of diabetes and interpreted severe events as situational and correctable when a cause was identifiable, or as inevitable when it was not, rather than as evidence of increased risk. Second, participants relied on prevention systems encompassing habitual routines, caregiver involvement, and glucose-monitoring technologies. Third, severe episodes were frightening and disruptive but typically prompted adjustments to personal management over pursuit of additional clinical support. Finally, reasons for declining Diabetes-REM included time constraints (56%), perceived lack of benefit (25%), and privacy concerns or discomfort with home visits (25%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Among adults who declined a community paramedicine hypoglycemia prevention intervention, severe events were absorbed into existing self-management frameworks rather than viewed as signals of increased risk. Programs targeting hypoglycemia recurrence should account for patients\u2019 risk perceptions and existing management systems, positioning support as complementary rather than corrective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/doc26-0061","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:09:21Z","timestamp":1785517761000},"page":"805-814","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["\u201cIt\u2019s Scary, but I Handle It\u201d: A Qualitative Study on Severe Hypoglycemia Experiences and Reasons for Declining to Participate in a Community Paramedicine Trial to Prevent Hypoglycemia Among People With Diabetes"],"prefix":"10.2337","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1015-3935","authenticated-orcid":false,"given":"Elizabeth H.","family":"Golembiewski","sequence":"first","affiliation":[{"name":"Department of Quantitative Health Sciences 1 , Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace L.","family":"Huang","sequence":"additional","affiliation":[{"name":"University of Maryland 2 , College Park, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Tokar","sequence":"additional","affiliation":[{"name":"University of Maryland 2 , College Park, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davi","family":"Jacobs","sequence":"additional","affiliation":[{"name":"University of Maryland 2 , College Park, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tami S.","family":"Krpata","sequence":"additional","affiliation":[{"name":"Research Services, Clinical Trials Office 3 , Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy J.S.","family":"Sundt","sequence":"additional","affiliation":[{"name":"Research Services, Clinical Trials Office 3 , Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2289-3183","authenticated-orcid":false,"given":"Rozalina G.","family":"McCoy","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine 4 , Baltimore, MD"},{"name":"University of Maryland Institute for Health Computing 5 , North Bethesda, MD"},{"name":"Mayo Clinic Ambulance 6 , Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"2026101610021881300_B1","doi-asserted-by":"crossref","first-page":"S132","DOI":"10.2337\/dc26-S006","article-title":"6. 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