Diabetes distress worse among adults with impaired hypoglycemia awareness
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Key takeaways:
- Adults with type 1 diabetes and impaired hypoglycemia awareness had worse diabetes distress than those with normal awareness.
- The findings remained consistent in a sensitivity analysis of CGM users.
Adults with type 1 diabetes and impaired awareness of hypoglycemia have worse diabetes-related distress than those with normal hypoglycemia awareness, according to a study published in Diabetic Medicine.
“Our study highlights the persistent relation between impaired awareness of hypoglycemia and diabetes distress with manifestations across emotions, cognitions and behaviors, despite the use of a [glucose] sensor,” Namam Ali, MD, resident in the department of internal medicine at Radboud University Medical Center in the Netherlands, and colleagues wrote. “Our data are broadly similar to that reported previously in populations with lower use of sensors.”
Ali and colleagues conducted a cross-sectional study of adolescents and adults aged 16 years and older with type 1 diabetes and no recent hospital admission for a psychiatric disorder or severe psychiatric comorbidity. Clinical data were obtained through questionnaires and verified through medical records. The Clarke questionnaire was administered to analyze hypoglycemia awareness status. Participants scoring at least four of a possible seven points were defined as having impaired hypoglycemia awareness. The study group also completed the Problem Areas in Diabetes Survey to measure diabetes-related emotional distress, the Hypoglycemia Fear Survey-II to measure fear of hypoglycemia, the Attitudes to Awareness of Hypoglycemia Survey to assess attitudes or beliefs into “problematic hypoglycemia,” the Nijmegen Clinical Screening Instrument to measure severity of hypoglycemic and hyperglycemic events and the Hyperglycemia Avoidance Scale to assess measures taken to prevent hyperglycemia.
There were 422 adults included in the study (51.9% men; mean age, 50 years), of whom 82 had impaired awareness of hypoglycemia and 340 had normal hypoglycemia awareness. The mean diabetes duration in the study group was 30 years and the mean HbA1c was 7.6%.
Of the participants, 24.2% had high diabetes-related emotional distress with a score on the Problem Areas in Diabetes Survey of at least eight points. High diabetes distress was more common in adults with impaired hypoglycemia awareness compared with those with normal hypoglycemia awareness (35.4% vs. 21.5%; P = .008). Adults with impaired hypoglycemia awareness also had greater hypoglycemia fear on the Hypoglycemia Fear Survey-II compared with those with normal hypoglycemia awareness.
The severity of hypoglycemia events was rated as more severe, more upsetting and with stronger emotions for those with impaired hypoglycemia awareness vs. adults with normal awareness. No differences were observed in severity of hyperglycemia. Adults with impaired hypoglycemia awareness had more worry and practiced more avoidance behaviors as measured on the Hyperglycemia Avoidance Scale compared with adults with normal hypoglycemia.
In sensitivity analysis examining only those using continuous glucose monitoring, the use of diabetes devices did not change the differences between adults with impaired hypoglycemia awareness and those with normal hypoglycemia awareness.
“Apparently, widespread use of intermittently scanned CGM technology has not closed this gap between impaired awareness of hypoglycemia and normal awareness of hypoglycemia,” the researchers wrote. “Further studies are needed to investigate intervention strategies, whether psychological or technological, to lower diabetes-specific distress, particularly in individuals who retain impaired awareness of hypoglycemia despite the use of a sensor.”
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