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Fariba A, Amerzadeh M, Banazadeh M, Rashidi S, Myaneh ZT. Fear of hypoglycemia and illness perception in type II diabetes patients. BMC Endocr Disord 2024; 24:24. [PMID: 38378559 PMCID: PMC10877786 DOI: 10.1186/s12902-024-01548-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Hypoglycemia, a prevalent acute complication among individuals with type 2 diabetes (T2D), manifests with varied symptoms. Those with diabetes who have previously encountered hypoglycemic episodes commonly develop a Fear of Hyperglycemia (FOH). Illness perception (IP) significantly affects self-care behaviors and health outcomes in individuals diagnosed with T2D. OBJECTIVE This study examined the correlation between IP and FOH among T2D patients and predictors of FOH. METHODS The present study employed a descriptive-analytical design. The target population for this investigation comprised patients diagnosed T2D who sought medical care at the clinic and endocrinology departments of a hospital affiliated with Alborz University of Medical Sciences. The data collection period spanned from August 2019 to March 2021. A total of 300 individuals were included in the sample. Questionnaires were administered to measure both IP and FOH. Statistical analysis was conducted to examine the association between IP and FOH, as well as to identify the predictors of FOH. RESULTS The results of the study indicated a statistically significant relationship between FOH and the mean score of IP among patients with diabetes (p = 0.001, r = 0.393), suggesting a moderate positive correlation between these variables. Additionally, the duration of illness, IP, and level of education were identified as variables that predicted FOH (p < 0.05). CONCLUSION The numerous factors that influence FOH in individuals diagnosed with T2D highlight the necessity for strategic planning and training initiatives aimed at enhancing IP and reducing FOH within this specific population. Healthcare providers should prioritize interventions that not only address patients' concerns but also contribute to the improvement of their overall well-being. By implementing such interventions, healthcare providers can optimize diabetes management strategies and ultimately enhance patient outcomes.
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Affiliation(s)
- Abdollahi Fariba
- Department of Medical Sciences, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Mohammad Amerzadeh
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Marjan Banazadeh
- School of Nursing, Alborz University of Medical Sciences, Karaj, Iran
| | - Saba Rashidi
- Student Reserch committe, Alborz University of Medical Sciences, Karaj, Iran
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Chatwin H, Broadley M, Hendrieckx C, Carlton J, Heller S, Amiel SA, de Galan B, McCrimmon RJ, Pedersen-Bjergaard U, Pouwer F, Speight J. The impact of hypoglycaemia on quality of life among adults with type 1 diabetes: Results from "YourSAY: Hypoglycaemia". J Diabetes Complications 2023; 37:108232. [PMID: 35927177 DOI: 10.1016/j.jdiacomp.2022.108232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 10/18/2022]
Abstract
AIMS Research on hypoglycaemia and quality of life (QoL) has focused mostly on severe hypoglycaemia and psychological outcomes, with less known about other aspects of hypoglycaemia (e.g., self-treated episodes) and impacts on other QoL domains (e.g., relationships). Therefore, we examined the impact of all aspects of hypoglycaemia on QoL in adults with type 1 diabetes (T1DM). METHODS Participants completed an online survey, including assessment of hypoglycaemia-specific QoL (using the 12-item Hypoglycaemia Impact Profile). Mann-Whitney U tests examined differences in hypoglycaemia-specific QoL by hypoglycaemia frequency, severity, and awareness. Hierarchical linear regression examined associations with QoL. RESULTS Participants were 1028 adults with T1DM (M ± SD age: 47 ± 15 years; diabetes duration: 27 ± 16 years). Severe and self-treated hypoglycaemia and impaired awareness negatively impacted on overall QoL and several QoL domains, including leisure activities, physical health, ability to keep fit/be active, sleep, emotional well-being, spontaneity, independence, work/studies, and dietary freedom. Diabetes distress was most strongly associated with hypoglycaemia-specific QoL, followed by generic emotional well-being, fear of hypoglycaemia, and confidence in managing hypoglycaemia. Hypoglycaemia frequency and awareness were no longer significantly associated with QoL once psychological factors were considered. CONCLUSIONS Hypoglycaemia negatively impacts on several QoL domains. Psychological factors supersede the effect of hypoglycaemia frequency and awareness in accounting for this negative impact.
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Affiliation(s)
- Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark; National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark.
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Jill Carlton
- School of Health Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Stephanie A Amiel
- Department of Diabetes, King's College London, London, United Kingdom
| | - Bastiaan de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands; Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Rory J McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark; School of Psychology, Deakin University, Geelong, Australia; Steno Diabetes Center Odense, Odense, Denmark
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark; School of Psychology, Deakin University, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
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Akhaury K, Wanjari A, Sinha AH, Kumar M. Hypoglycemia and Cardiovascular Disease: Exploring the Connections. Cureus 2023; 15:e47784. [PMID: 38022365 PMCID: PMC10676516 DOI: 10.7759/cureus.47784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
It has long been known that administering insulin or insulin secretagogues to treat diabetes has the unfavorable side effect of hypoglycemia. Because hypoglycemia can disrupt normal brain function, it can have a profound impact on people's lives. Studies have shown a connection between hypoglycemia and a higher risk of death and cardiovascular disease. Through experimental studies, numerous potential reasons for the start of cardiovascular events have been discovered. In addition, studies on people have demonstrated that hypoglycemia can result in ventricular arrhythmias. According to recent studies, a number of factors may affect the relationship between hypoglycemia, cardiovascular events, and mortality. Confounding factors may explain the apparent correlation, at least in part. People with comorbidities may experience more hypoglycemia, increasing their risk of mortality. Those who have type 1 or type 2 diabetes, however, seem to be more susceptible to the negative effects of hypoglycemia on the cardiovascular system. When choosing appropriate glucose-lowering treatments and setting glycemic objectives with patients, clinicians should be aware of this risk.
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Affiliation(s)
- Kishan Akhaury
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anil Wanjari
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arya Harshyt Sinha
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayank Kumar
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Cha E, Joung KH, Shin YA, Son NH, Kim HJ, Faulkner MS. Comparisons of Psycho-Behavioral Factors, Body Composition, and Clinical Outcomes in Adults With Type 2 Diabetes by Perceived Hypoglycemia. Sci Diabetes Self Manag Care 2023; 49:351-361. [PMID: 37658651 DOI: 10.1177/26350106231192362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE The purpose of the study was to examine the associations between perceived hypoglycemia and psycho-behavioral and clinical factors in persons with type 2 diabetes (T2D). METHODS Adults with T2D were recruited from outpatient clinics in a university hospital in Korea. Sociodemographics, psycho-behavioral and clinical factors, and body composition were assessed. The participants were divided into 2 groups reporting perceived hypoglycemia or not in the previous month based on an item of the Control Problem Scale. Group differences were compared at α = .05 using SPSS (version 26.0). RESULTS Of 177 participants, approximately one-third (n = 67) perceived hypoglycemia. The hypoglycemia group reported poor health-related quality of life, frequent blood monitoring and foot care, and sleep difficulties. However, no differences between groups were identified for diet, exercise, or glycosylated hemoglobin. The hypoglycemia group had a lower body mass index and a trend toward a lower skeletal muscle mass and fat free mass. CONCLUSIONS Perceived hypoglycemia was associated with psycho-behavioral factors and body composition. Importantly, some persons on oral antidiabetic medications that do not cause hypoglycemia still perceived hypoglycemia. Further investigation is warranted to examine the efficacy of strategies to minimize hypoglycemia and inappropriate fear of hypoglycemia. In addition, clinicians should be aware of the potential risk of hypoglycemia in persons with lower muscle mass.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, South Korea
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Kyong Hye Joung
- Department of Internal Medicine, Chungnam National University, Daejeon, South Korea
| | - Yun-A Shin
- College of Sport Science, Dankook University, Cheonan, South Korea
| | - Nak-Hoon Son
- College of Natural Science, Department of Statistics, Keimyung University, Daegu, South Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University, Daejeon, South Korea
| | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
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Ali N, El Hamdaoui S, Nefs G, Walburgh Schmidt JWJ, Tack CJ, de Galan BE. High diabetes-specific distress among adults with type 1 diabetes and impaired awareness of hypoglycaemia despite widespread use of sensor technology. Diabet Med 2023; 40:e15167. [PMID: 37347681 DOI: 10.1111/dme.15167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
AIMS Impaired awareness of hypoglycaemia (IAH) has been associated with increased diabetes distress and use of sensor technology can reduce diabetes distress. The aim of this study was to examine diabetes-specific distress (emotions, cognitions, behaviours) in relation to IAH status and use of glucose sensors in people with type 1 diabetes. METHODS Individuals with type 1 diabetes from an academic diabetes outpatient clinic completed the Clarke questionnaire (to assess hypoglycaemic awareness), Problem Areas in Diabetes (PAID-5), Hypoglycaemia Fear Survey-II (HFS-II), Attitudes to Awareness of Hypoglycaemia Survey (A2A), Nijmegen Clinical Screening Instrument Survey (NCSI) and Hyperglycaemia Avoidance Scale (HAS). RESULTS Of the 422 participants (51.9% male, diabetes duration 30 [16-40] years, HbA1c 60 ± 11 mmol/mol [7.6 ± 1.0%], 351 [88.2%] used a glucose sensor; 82 [19.4%]) had IAH. Compared to individuals with normal awareness, those with IAH more often had PAID-5 scores ≥8 (35.4% vs. 21.5%, p = 0.008) and higher scores on all HFS-II subscores (total [40.2 ± 21.5 vs. 27.9 ± 17.2, p < 0.001]), HFS-II behaviour (18.5 ± 10.0 vs. 15.1 ± 8.0, p = 0.005), HFS-II worry (21.8 ± 13.5 vs. 12.7 ± 10.9, p < 0.001), HAS worries (17.5 ± 7.3 vs. 14.3 ± 7.0, p < 0.001) and NCSI hypoglycaemia items. HAS behaviour, A2A and NCSI hyperglycaemia scores did not differ between individuals with or without IAH. Restricting the analyses to individuals using a glucose sensor did not materially change the results. CONCLUSIONS Diabetes-specific distress remains a major problem among individuals with type 1 diabetes, particularly those with IAH, despite the widespread use of (intermittently scanned) sensor technology. Further studies are needed to examine strategies to lower diabetes-specific distress in individuals with IAH.
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Affiliation(s)
- Namam Ali
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Soumia El Hamdaoui
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
- Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
| | | | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands
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Bishop E, Allington D, Ringrose T, Martin C, Aldea A, García-Jaramillo M, León-Vargas F, Leal Y, Henao D, Gómez AM. Design and Usability of an Avatar-Based Learning Program to Support Diabetes Education: Quality Improvement Study in Colombia. J Diabetes Sci Technol 2023; 17:1142-1153. [PMID: 36377096 PMCID: PMC10563524 DOI: 10.1177/19322968221136141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This quality improvement study, entitled Avatar-Based LEarning for Diabetes Optimal Control (ABLEDOC), explored the feasibility of delivering an educational program to people with diabetes in Colombia. The aim was to discover how this approach could be used to improve awareness and understanding of the condition, the effects of treatment, and strategies for effective management of blood-glucose control. METHODS Individuals with diabetes were recruited by Colombian endocrinologists to a human-centered study to codesign the educational program, using the Double Diamond model. Participants contributed to two phases. The first phase focused on gathering unmet educational needs and choice of curriculum. Three prototypes were developed as a result. During phase 2, a different group of participants engaged with the program for several weeks, before reporting back. RESULTS Thirty-six participants completed a Web survey during phase 1, and five were also interviewed by telephone. The majority (33 of 36; 91%) were receptive to the prospect of educational interventions and ranked the chosen topic of hypoglycemia highly. In phase 2, the three prototypes were tested by 17 participants, 10 of whom also gave feedback in focus groups. The response was overwhelmingly positive, with 16 of 17 (94%) stating they would use a program like this again. The 3D version was the most highly rated. CONCLUSIONS Immersive, avatar-based programs, delivered through smartphone, have the potential to deliver educational information that is trusted, engaging, and useful. Future work includes expansion of the curriculum, evaluation with a larger group, and exploration of the prospective role of artificial intelligence in personalizing this form of educational intervention.
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Affiliation(s)
| | | | | | - Clare Martin
- Faculty of Technology, Design and
Environment, Oxford Brookes University, Oxford, UK
| | - Arantza Aldea
- Faculty of Technology, Design and
Environment, Oxford Brookes University, Oxford, UK
| | | | - Fabian León-Vargas
- Faculty of Mechanical, Electronic and
Biomedical Engineering, Universidad Antonio Nariño, Bogotá, Colombia
| | - Yenny Leal
- Institut d’Investigació Biomèdica de
Girona Dr. Josep Trueta, Girona, Spain
| | - Diana Henao
- Endocrinology Unit, Hospital
Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana Maria Gómez
- Endocrinology Unit, Hospital
Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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Li XN, Kan YS, Liu HY, Pang J, He YY, Liu L, Zou Y, Zhang N, Zhang Y. Prevalence and contributing factors of impaired awareness of hypoglycemia in patients with type 2 diabetes: a meta-analysis. Acta Diabetol 2023; 60:1155-1169. [PMID: 37199797 DOI: 10.1007/s00592-023-02102-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
AIMS To conduct a systematic review to summarize the definition, measurement tools, prevalence, and contributing factors of impaired awareness of hypoglycemia (IAH) in type 2 diabetes mellitus (T2DM). METHODS A reproducible search strategy was used to identify factors affecting IAH in T2DM in PubMed, MEDLINE, EMBASE, Cochrane, PsycINFO, and CINAHL from inception until 2022. Literature screening, quality evaluation, and information extraction were performed independently by 2 investigators. A meta-analysis of prevalence was performed using Stata 17.0. RESULTS The pooled prevalence of IAH in patients with T2DM was 22% (95%CI:14-29%). Measurement tools included the Gold score, Clarke's questionnaire, and the Pedersen-Bjergaard scale. IAH in T2DM was associated with sociodemographic factors (age, BMI, ethnicity, marital status, education level, and type of pharmacy patients visited), clinical disease factors (disease duration, HbAlc, complications, insulin therapy regimen, sulfonylureas use, and the frequency and severity of hypoglycemia), and behavior and lifestyle (smoking and medication adherence). CONCLUSION The study found a high prevalence of IAH in T2DM, with an increased risk of severe hypoglycemia, suggesting that medical workers should take targeted measures to address sociodemographic factors, clinical disease, and behavior and lifestyle to reduce IAH in T2DM and thus reduce hypoglycemia in patients.
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Affiliation(s)
- Xiang-Ning Li
- School of Nursing, Yangzhou University, Jiangyang Road 136, Yangzhou, China
| | - Yin-Shi Kan
- School of Nursing, Yangzhou University, Jiangyang Road 136, Yangzhou, China
| | - Hong-Yuan Liu
- School of Nursing, Yangzhou University, Jiangyang Road 136, Yangzhou, China
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Jiangsu Key Laboratory of Zoonosis, Yangzhou University, Yangzhou, China
| | - Juan Pang
- School of Nursing, Yangzhou University, Jiangyang Road 136, Yangzhou, China
| | - Yu-Ying He
- School of Nursing, Yangzhou University, Jiangyang Road 136, Yangzhou, China
| | - Lin Liu
- School of Nursing, Yangzhou University, Jiangyang Road 136, Yangzhou, China
| | - Yan Zou
- School of Nursing, Yangzhou University, Jiangyang Road 136, Yangzhou, China
| | - Ning Zhang
- School of Nursing, Yangzhou University, Jiangyang Road 136, Yangzhou, China
| | - Yu Zhang
- School of Nursing, Yangzhou University, Jiangyang Road 136, Yangzhou, China.
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Jiangsu Key Laboratory of Zoonosis, Yangzhou University, Yangzhou, China.
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Zeitoun MH, Abdel Reheem AA, Kharboush IF, Sheshtawy H, Assad DH, El Feky AY. Relationship between depressive and anxiety symptoms and fear of hypoglycemia among adolescents and adults with type 1 diabetes mellitus. Prim Care Diabetes 2023; 17:255-259. [PMID: 36925404 DOI: 10.1016/j.pcd.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND AND AIMS Emotional problems including anxiety, depression and fear of hypoglycemia (FOH) are common in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to determine the prevalence of depressive and anxiety symptoms among patients with T1DM and their relation to glycemic control, diabetes complications and to FOH. METHODS This study included 325 patients with T1DM. Anxiety and depressive symptoms were assessed by Hospital Anxiety and Depression Scale (HADS) and FOH was assessed by Hypoglycemia Fear Survey II (HFS-II). Glycemic control was assessed by both fasting plasma glucose and HbA1c. A subsample of 75 patients was screened for diabetes complications. RESULTS The prevalence of anxiety symptoms, depressive symptoms and FOH was 76.3%, 61.8% and 20% respectively. Female sex was related to depressive symptoms but not to anxiety symptoms. Logistic regression analysis showed that both HbA1c and HFS-II total score were independently correlated with both anxiety symptoms and depressive symptoms. Age showed independent correlation with both HFS-II (total score) and with Hypoglycemia Fear Survey-worry (HFS-W) while HbA1c showed independent correlation with Hypoglycemia Fear Survey-behavior (HFS-B). Both anxiety and depressive symptoms were positively correlated to HFS-B score, HFS-W score and HFS-II total score. CONCLUSIONS FOH is not uncommon among Egyptian patients with T1DM and it seems to be one of the factors contributing to the increased prevalence of anxiety and depressive symptoms among those individuals. Addressing and managing the different psychological aspects of diabetes should be integrated within the routine diabetes care services for people with T1DM.
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Affiliation(s)
| | | | - Ibrahim F Kharboush
- Department of Maternal and Child Health, High Institute of Public Health, Alexandria University, Egypt
| | - Hesham Sheshtawy
- Department of Neurology and Psychiatry, Alexandria University, Egypt
| | - Dalia H Assad
- Department of Internal Medicine, Abu Qir general hospital, Alexandria, Egypt
| | - Amr Y El Feky
- Department of Internal Medicine, Alexandria University, Egypt.
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Polonsky WH, Guzman SJ, Fisher L. The Hypoglycemic Fear Syndrome: Understanding and Addressing This Common Clinical Problem in Adults With Diabetes. Clin Diabetes 2023; 41:502-509. [PMID: 37849521 PMCID: PMC10577500 DOI: 10.2337/cd22-0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Although a broad literature on fear of hypoglycemia and its impact on people with type 1 or type 2 diabetes has accumulated over the past three decades, there has been surprisingly little guidance concerning how best to tackle this problem in clinical care. The aim of this article is to begin filling this gap by describing the "hypoglycemic fear syndrome," which we define as hypoglycemic fear that has become so overwhelming that it leads to avoidance behaviors and chronically elevated glucose levels. We begin by presenting several illustrative cases, describing the syndrome and how it is most commonly presented in clinical care, and detailing its most common precipitants. We then offer practical, evidence-based strategies for clinical intervention, based on the literature and our clinical experience.
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Affiliation(s)
- William H. Polonsky
- Behavioral Diabetes Institute, San Diego, CA
- University of California, San Diego, San Diego, CA
| | | | - Lawrence Fisher
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA
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Liu J, Poon JL, Bispham J, Perez-Nieves M, Hughes A, Chapman K, Mitchell B, Hood K, Snoek F, Fisher L. Development and validation of fear of hypoglycemia screener: results from the T1D exchange registry. J Patient Rep Outcomes 2023; 7:43. [PMID: 37160500 PMCID: PMC10169988 DOI: 10.1186/s41687-023-00585-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Fear of Hypoglycemia (FoH) in people with diabetes has a significant impact on their quality of life, psychological well-being, and self-management of disease. There are a few questionnaires assessing FoH in people living with diabetes, but they are more often used in research than clinical practice. This study aimed to develop and validate a short and actionable FoH screener for adults living with type 1 diabetes (T1D) for use in routine clinical practice. METHODS We developed an initial screener based on literature review and, interviews with healthcare providers (HCPs) and people with T1D. We developed a cross-sectional web-based survey, which was then conducted to examine the reliability and validity of the screener. Adults (aged ≥ 18 years) with diagnosis of T1D for ≥ 1 year were recruited from the T1D Exchange Registry (August-September 2020). The validation analyses were conducted using exploratory factor analyses, correlation, and multivariable regression models for predicting cut-off scores for the final screener. RESULTS The final FoH screener comprised nine items assessing two domains, "worry" (6-items) and "avoidance behavior" (three items), in 592 participants. The FoH screener showed good internal consistency (Cronbach's α = 0.88). The screener also demonstrated high correlations (r = 0.71-0.75) with the Hypoglycemia Fear Survey and moderate correlations with depression, anxiety, and diabetes distress scales (r = 0.44-0.66). Multivariable regression analysis showed that higher FoH screener scores were significantly associated with higher glycated hemoglobin (HbA1c) (b = 0.04) and number of comorbidities (b = 0.03). CONCLUSIONS This short FoH screener demonstrated good reliability and validity. Further research is planned to assess clinical usability to identify patients with FoH and assist effective HCP-patient conversations.
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Affiliation(s)
| | - Jiat-Ling Poon
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | | | | | | | - Beth Mitchell
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - Korey Hood
- Stanford University School of Medicine, Stanford, CA, USA
| | - Frank Snoek
- Department of Medical Psychology Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lawrence Fisher
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
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Sepúlveda E, Jacob P, Poínhos R, Carvalho D, Vicente SG, Smith EL, Shaw JAM, Speight J, Choudhary P, de Zoysa N, Amiel SA. Changes in attitudes to awareness of hypoglycaemia during a hypoglycaemia awareness restoration programme are associated with avoidance of further severe hypoglycaemia episodes within 24 months: the A2A in HypoCOMPaSS study. Diabetologia 2023; 66:631-641. [PMID: 36538062 PMCID: PMC9947080 DOI: 10.1007/s00125-022-05847-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/06/2022] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS The aims of this study were to assess cognitions relating to hypoglycaemia in adults with type 1 diabetes and impaired awareness of hypoglycaemia before and after the multimodal HypoCOMPaSS intervention, and to determine cognitive predictors of incomplete response (one or more severe hypoglycaemic episodes over 24 months). METHODS This analysis included 91 adults with type 1 diabetes and impaired awareness of hypoglycaemia who completed the Attitudes to Awareness of Hypoglycaemia (A2A) questionnaire before, 24 weeks and 24 months after the intervention, which comprised a short psycho-educational programme with optimisation of insulin therapy and glucose monitoring. RESULTS The age and diabetes duration of the participants were 48±12 and 29±12 years, respectively (mean±SD). At baseline, 91% reported one or more severe hypoglycaemic episodes over the preceding 12 months; this decreased to <20% at 24 weeks and after 24 months (p=0.001). The attitudinal barrier 'hyperglycaemia avoidance prioritised' (η2p=0.250, p=0.001) decreased from baseline to 24 weeks, and this decrease was maintained at 24 months (mean±SD=5.3±0.3 vs 4.3±0.3 vs 4.0±0.3). The decrease in 'asymptomatic hypoglycaemia normalised' from baseline (η2p=0.113, p=0.045) was significant at 24 weeks (1.5±0.3 vs 0.8±0.2). Predictors of incomplete hypoglycaemia response (one or more further episodes of severe hypoglycaemia) were higher baseline rates of severe hypoglycaemia, higher baseline scores for 'asymptomatic hypoglycaemia normalised', reduced change in 'asymptomatic hypoglycaemia normalised' scores at 24 weeks, and lower baseline 'hypoglycaemia concern minimised' scores (all p<0.05). CONCLUSIONS/INTERPRETATION Participation in the HypoCOMPaSS RCT was associated with improvements in hypoglycaemia-associated cognitions, with 'hyperglycaemia avoidance prioritised' most prevalent. Incomplete prevention of subsequent severe hypoglycaemia episodes was associated with persistence of the cognition 'asymptomatic hypoglycaemia normalised'. Understanding and addressing cognitive barriers to hypoglycaemia avoidance is important in individuals prone to severe hypoglycaemia episodes. CLINICAL TRIALS REGISTRATION www.isrctn.org : ISRCTN52164803 and https://eudract.ema.europa.eu : EudraCT2009-015396-27.
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Affiliation(s)
- Eduardo Sepúlveda
- Diabetes Research Group, King's College London, London, UK
- Centre for Psychology at Universidade do Porto, Faculty of Psychology and Educational Sciences, Universidade do Porto, Porto, Portugal
| | - Peter Jacob
- Diabetes Research Group, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Rui Poínhos
- Faculty of Nutrition and Food Sciences, Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Selene G Vicente
- Centre for Psychology at Universidade do Porto, Faculty of Psychology and Educational Sciences, Universidade do Porto, Porto, Portugal
| | - Emma L Smith
- Diabetes Research Group, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - James A M Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Pratik Choudhary
- Diabetes Research Group, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Nicole de Zoysa
- Diabetes Research Group, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Stephanie A Amiel
- Diabetes Research Group, King's College London, London, UK.
- King's College Hospital NHS Foundation Trust, London, UK.
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Charleer S, De Block C, Bolsens N, Van Huffel L, Nobels F, Mathieu C, Gillard P. Sustained Impact of Intermittently Scanned Continuous Glucose Monitoring on Treatment Satisfaction and Severe Hypoglycemia in Adults with Type 1 Diabetes (FUTURE): An Analysis in People with Normal and Impaired Awareness of Hypoglycemia. Diabetes Technol Ther 2023; 25:231-241. [PMID: 36648249 DOI: 10.1089/dia.2022.0452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective: Nationwide reimbursement of intermittently scanned continuous glucose monitoring (isCGM) was introduced in Belgium (2016). This real-world observational study investigates the impact of isCGM over 24 months on adults with type 1 diabetes with impaired or normal awareness of hypoglycemia (IAH or NAH). Methods: We included 1905 people who started first-generation 14-day FreeStyle Libre (without alerts). Sixteen percent had IAH. Primary endpoint was evolution of quality of life (QOL); secondary endpoints were evolution of severe hypoglycemia, work absenteeism, glycated hemoglobin (HbA1c), and sensor-measured outcomes. Results: At baseline, people with IAH (n = 308) had significantly worse QOL than people with NAH (n = 1594). Only people with IAH improved on the hypoglycemia fear survey-worry subscale after 24 months (22.8 [95% confidence interval: 21.4-24.2] at baseline; 20.6 [19.0-22.1] at 24 months, P = 0.002). For both groups, Diabetes Treatment Satisfaction Scale improved over 24 months (IAH: +3.1 [2.1-4.1], P < 0.001; NAH: +2.3 [1.9-2.7], P < 0.001), whereas general QOL, diabetes distress, and HbA1c remained stable. People with IAH showed the strongest decline in work absenteeism and severe hypoglycemia (36.4% having an event 6 months before isCGM initiation; 16.0% having an event during last 6 months of follow-up, P < 0.001), with similar observations for hypoglycemia hospitalization and hypoglycemia coma. Over 24 months, people with IAH spent more time in hypoglycemia, but less time in hyperglycemia than people with NAH. Conclusion: These data show sustained improvement of severe hypoglycemia, work absenteeism, and hypoglycemia fear after isCGM reimbursement, mostly driven by people with IAH. Together with improved treatment satisfaction, irrespective of hypoglycemia awareness level, isCGM without alerts is a valuable tool under long-term real-world conditions. Clinical Trial Registration number: NCT02898714.
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Affiliation(s)
- Sara Charleer
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolism, University of Antwerp-Antwerp University Hospital, Edegem, Belgium
| | - Nancy Bolsens
- Department of Endocrinology, Diabetology and Metabolism, University of Antwerp-Antwerp University Hospital, Edegem, Belgium
| | | | - Frank Nobels
- Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
- Fonds Wetenschappelijk Onderzoek (FWO), Brussels, Belgium
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13
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Stuckey HL, Desai U, Mitchell BD, Pearson TL. 'Didn't See the Need': Misperceptions about glucagon from the perspectives of people with diabetes and their caregivers. Diabet Med 2023; 40:e15084. [PMID: 36924085 DOI: 10.1111/dme.15084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
AIMS Severe hypoglycaemia among people with diabetes who use insulin can be a life-threatening complication if left untreated. Although glucagon has been approved for treatment of hypoglycaemia since the 1960s, it has been underutilized. We aimed to understand the perceptions of people with diabetes and their caregivers about glucagon. METHODS We conducted in-depth, one-on-one telephone interviews with people with diabetes and their caregivers in the United States. The interviews included questions around general awareness of glucagon, reasons for owning or not owning glucagon, and suggestions for improving understanding of glucagon as treatment for severe hypoglycaemia. Initial synopsis and inductive codebook schema were used to analyse the responses by two independent researchers. Themes were developed from the codes, and codes were re-mapped back to the themes. RESULTS There were 60 dyads of people with diabetes and their caregivers (N = 120). Four themes developed from the interviews: (1) for most participants, the stated reasons for not owning or renewing a prescription for glucagon included unawareness of the medication, its advantages and its value; (2) misperceptions about glucagon occurred frequently; (3) caregivers often lacked confidence in administering reconstituted injectable glucagon; and (4) education and training from healthcare providers about glucagon would be welcomed. CONCLUSIONS This study emphasizes the need for healthcare providers to discuss hypoglycaemia prevention and events at each clinical visit, including the use of glucagon in the case of severe hypoglycaemia. Healthcare providers are encouraged to assess the knowledge of people with diabetes and their caregivers regarding treatment and prevention of hypoglycaemia.
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Affiliation(s)
- Heather L Stuckey
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, 17033, USA
| | - Urvi Desai
- Analysis Group, Boston, Massachusetts, 02199, USA
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14
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Parent C, Lespagnol E, Berthoin S, Tagougui S, Heyman J, Stuckens C, Gueorguieva I, Balestra C, Tonoli C, Kozon B, Fontaine P, Weill J, Rabasa-Lhoret R, Heyman E. Barriers to Physical Activity in Children and Adults Living With Type 1 Diabetes: A Complex Link With Real-life Glycemic Excursions. Can J Diabetes 2023; 47:124-132. [PMID: 36411182 DOI: 10.1016/j.jcjd.2022.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Ever since the first research on barriers to physical activity (PA) highlighting fear of hypoglycemia as a major barrier, many studies have attempted to understand their demographic and behavioural determinants. However, no research has been conducted on whether these perceived barriers toward PA are based on real-life-experienced adverse glycemic effects of exercise. METHODS Sixty-two adults and 53 children/adolescents living with type 1 diabetes, along with their parents, completed the Barriers to Physical Activity in Type 1 Diabetes-1 (BAPAD-1) questionnaire on barriers to PA. Continuous glucose-monitoring data were collected during 1 week of everyday life for 26 adults and 33 children/adolescents. Multiple linear regressions were used to explore links between BAPAD-1 scores and glycemic excursions experienced during and after everyday-life self-reported PA sessions, controlling for behavioural (accelerometry) and demographic confounders. RESULTS In children/adolescents, the more time spent in hypoglycemia on nights after PA sessions, the more they reported hypoglycemic risk as a barrier (ß=+0.365, p=0.034). Conversely, in adults, the higher the proportion of PA sessions accompanied by a drop in blood glucose, the less hypoglycemia was a barrier (ß=-0.046, p=0.004). In parents, BAPAD-1 scores were unrelated to children/adolescents' everyday-life exercise-induced hypo/hyperglycemia. CONCLUSIONS In children/adolescents, fear of hypoglycemia was predominant in those exposed to nocturnal hypoglycemia associated with PA sessions. In adults, fewer barriers may mean they accept a bigger drop in their glycemia during PA. This shows the importance of finding and promoting age-specific solutions to prevent exercise-induced hypoglycemia.
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Affiliation(s)
- Cassandra Parent
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France
| | - Elodie Lespagnol
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France
| | - Serge Berthoin
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France
| | - Sémah Tagougui
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France
| | - Joris Heyman
- CNRS, UMR 6118, Transferts d'eau et de matière dans les milieux hétérogènes complexes-Géosciences, Université Rennes, Rennes, France
| | - Chantal Stuckens
- Department of Pediatrics, Lille University Hospital, Lille, France
| | - Iva Gueorguieva
- Department of Pediatrics, Lille University Hospital, Lille, France
| | - Costantino Balestra
- Laboratory of Environmental and Occupational (Integrative) Physiology, Haute Ecole Bruxelles-Brabant, Auderghem, Brussels, Belgium
| | - Cajsa Tonoli
- Human Physiology Research Group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bérengère Kozon
- Department of Diabetology, Lille University Hospital, Lille, France
| | - Pierre Fontaine
- Department of Diabetology, Lille University Hospital, Lille, France
| | - Jacques Weill
- Department of Pediatrics, Lille University Hospital, Lille, France
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada; Department of Nutrition, Université de Montréal, Montréal, Québec, Canada
| | - Elsa Heyman
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France; Institut Universitaire de France, Paris, France.
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15
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Talbo MK, Rabasa-Lhoret R, Yale JF, Peters TM, Brazeau AS. Are nocturnal hypoglycemia prevention strategies influenced by diabetes technology usage? A BETTER registry analysis. Diabetes Res Clin Pract 2022; 191:110080. [PMID: 36099973 DOI: 10.1016/j.diabres.2022.110080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 12/24/2022]
Abstract
AIM To assess the association of nocturnal hypoglycemia prevention strategies (NH-PS) and diabetes technology usage (insulin pump and/or continuous glucose monitors [CGM]) in people with type 1 diabetes (PWT1D). METHODS Logistic regression models were used to describe associations between self-reported NH-PS and diabetes technology (pump with intermittently-scanned or real-time CGM (isCGM or rtCGM), or automated insulin delivery (AID)), hypoglycemia history, and fear of hypoglycemia (FOH). RESULTS Among 831 adults (65 % female, aged 44 ± 15 years, T1D duration 26 ± 15 years), 32 % reported HbA1c ≤ 7.0 %, 88 % used ≥ 1 diabetes technology, 66 % reported ≥ 1 symptomatic NH in the past month, and 64 % used ≥ 2 NH-PS. Compared to multiple daily injections (MDI) + capillary blood glucose (CBG), bedtime snack consumption was less likely among pump + isCGM (OR [95 %CI]: 0.55 [0.31, 0.98]), pump + rtCGM (0.40 [0.20, 0.81]), and AID (0.34 [0.17, 0.66]) users, while evening insulin basal reduction was associated with CSII + CBG (3.15 [1.25, 7.99]), pump + isCGM 4.00 [1.99, 8.01]), and pump + rtCGM 2.89 [1.28, 6.50] use. Elevated FOH was associated with snack consumption (1.37 [1.00, 1.89]), evening bolus insulin avoidance (1.77 [1.11, 2.83]), limiting exercise (2.50 [1.30, 4.82]), and limiting alcohol consumption (2.33 [1.15, 4.70]) as NH-PS. CONCLUSION Technology use and elevated FOH might influence PWT1D' choice of NH-PS.
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Affiliation(s)
- Meryem K Talbo
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec H9X 3V9, Canada
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal Université de Montréal, 110 Pine Ave W, Montréal, Québec H2W 1R7, Canada; Division of Endocrinology and Metabolism, Centre hospitalier de l'Université de Montréal, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, QC H2X 0A9, Canada
| | - Jean-François Yale
- Division of Endocrinology and Metabolism, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Tricia M Peters
- Lady Davis Institute of Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; The Jewish General Hospital, Division of Endocrinology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec H9X 3V9, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, QC H2X 0A9, Canada.
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16
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Przezak A, Bielka W, Molęda P. Fear of hypoglycemia-An underestimated problem. Brain Behav 2022; 12:e2633. [PMID: 35620854 PMCID: PMC9304823 DOI: 10.1002/brb3.2633] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Fear of hypoglycemia (FOH) is a phenomenon that affects people with diabetes experiencing hypoglycemia. On the one hand, FOH is an adaptive mechanism that helps to protect patients from hypoglycemia and its consequences. On the other hand, the non-normative level of FOH causes anxiety and tension, disturbs normal functioning, and makes normoglycemia maintenance difficult. OBJECTIVE The main objective of this review was to describe factors influencing FOH and methods of measurement of FOH levels. Moreover, we highlighted the impact of the new technologies used in diabetes therapy on FOH and different therapeutic possibilities helping patients cope with excessive levels of FOH. We also presented clinical cases of patients with high FOH levels met in clinical practice and discussed methods to better diagnose and assist people with this kind of problem. METHODS We searched for studies and articles via PubMed using the keywords fear of hypoglycemia, diabetes, and hypoglycemia. From screened documents identified from literature search, 67 articles were included in our review. RESULTS We divided results from literature screening into five parts: fear of hypoglycemia and hypoglycemia definition, risk factors for the FOH, methods of measuring levels of FOH, therapies for the FOH, and modern technologies. We also described clinical examples of abnormal fear of hypoglycemia in patients. CONCLUSION The review highlights the importance of taking into consideration fear of hypoglycemia phenomenon in diabetic patients in everyday clinical practice.
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Affiliation(s)
- Agnieszka Przezak
- Department of Diabetology and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Weronika Bielka
- Department of Diabetology and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Molęda
- Department of Diabetology and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
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17
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Jacob P, Potts L, Maclean RH, de Zoysa N, Rogers H, Gonder-Frederick L, Smith EL, Kariyawasam D, Brooks A, Heller S, Toschi E, Kendall M, Bakolis I, Choudhary P, Goldsmith K, Amiel SA. Characteristics of adults with type 1 diabetes and treatment-resistant problematic hypoglycaemia: a baseline analysis from the HARPdoc RCT. Diabetologia 2022; 65:936-948. [PMID: 35325258 PMCID: PMC8943518 DOI: 10.1007/s00125-022-05679-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
AIMS/HYPOTHESIS Problematic hypoglycaemia still complicates insulin therapy for some with type 1 diabetes. This study describes baseline emotional, cognitive and behavioural characteristics in participants in the HARPdoc trial, which evaluates a novel intervention for treatment-resistant problematic hypoglycaemia. METHODS We documented a cross-sectional baseline description of 99 adults with type 1 diabetes and problematic hypoglycaemia despite structured education in flexible insulin therapy. The following measures were included: Hypoglycaemia Fear Survey II (HFS-II); Attitudes to Awareness of Hypoglycaemia questionnaire (A2A); Hospital Anxiety and Depression Index; and Problem Areas In Diabetes. k-mean cluster analysis was applied to HFS-II and A2A factors. Data were compared with a peer group without problematic hypoglycaemia, propensity-matched for age, sex and diabetes duration (n = 81). RESULTS The HARPdoc cohort had long-duration diabetes (mean ± SD 35.8 ± 15.4 years), mean ± SD Gold score 5.3 ± 1.2 and a median (IQR) of 5.0 (2.0-12.0) severe hypoglycaemia episodes in the previous year. Most individuals had been offered technology and 49.5% screened positive for anxiety (35.0% for depression and 31.3% for high diabetes distress). The cohort segregated into two clusters: in one (n = 68), people endorsed A2A cognitive barriers to hypoglycaemia avoidance, with low fear on HFS-II factors; in the other (n = 29), A2A factor scores were low and HFS-II high. Anxiety and depression scores were significantly lower in the comparator group. CONCLUSIONS/INTERPRETATION The HARPdoc protocol successfully recruited people with treatment-resistant problematic hypoglycaemia. The participants had high anxiety and depression. Most of the cohort endorsed unhelpful health beliefs around hypoglycaemia, with low fear of hypoglycaemia, a combination that may contribute to persistence of problematic hypoglycaemia and may be a target for adjunctive psychological therapies.
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Affiliation(s)
- Peter Jacob
- Department of Diabetes, Faculty of Life Sciences, King's College London, London, UK.
| | - Laura Potts
- Department of Biostatistics & Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre for Implementation Science, Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Rory H Maclean
- Department of Diabetes, Faculty of Life Sciences, King's College London, London, UK
| | - Nicole de Zoysa
- Centre for Implementation Science, Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Helen Rogers
- King's College Hospital NHS Foundation Trust, London, UK
| | - Linda Gonder-Frederick
- Centre for Diabetes Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Emma L Smith
- Centre for Implementation Science, Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Augustin Brooks
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | | | - Elena Toschi
- Joslin Diabetes Centre, Harvard Medical School, Boston, MA, USA
| | - Mike Kendall
- HARPdoc Patient Group, Department of Diabetes, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre for Implementation Science, Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Pratik Choudhary
- Department of Diabetes, Faculty of Life Sciences, King's College London, London, UK
- University of Leicester, Leicester, UK
| | - Kimberley Goldsmith
- Department of Biostatistics & Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Stephanie A Amiel
- Department of Diabetes, Faculty of Life Sciences, King's College London, London, UK
- Centre for Implementation Science, Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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18
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Shen Z, Xu J, Yin W, Liu Q, Fan M, Luo C. Common Sense Model program on illness perceptions in patients with impaired awareness of hypoglycemia. Contemp Nurse 2022; 58:171-191. [PMID: 35477371 DOI: 10.1080/10376178.2022.2071311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Illness perceptions are important for patients with insulin-treated type 2 diabetes mellitus (T2DM) and impaired awareness of hypoglycemia (IAH), as they determine health-related behaviors and motivations. Patients with IAH in many countries have poor illness perception, and there is a paucity of research exploring the effectiveness of Common Sense Model (CSM)-based interventions in this population. OBJECTIVE To investigate the effects of a CSM-based intervention program on perceptions of illness in patients with insulin-treated T2DM and IAH. DESIGN Quasi-randomized controlled trialMethods: 78 patients with IAH receiving routine care were included. The intervention group (n = 39) participated in a CSM-based program, whereas the control group (n = 39) did not. Illness perceptions, coping styles, hypoglycemia fear, and awareness of hypoglycemia at baseline, 1 month, and 3 months were analyzed and compared between the two groups. RESULTS The intervention group exhibited significant improvements in consequences (β = -1.615, P = 0.032); personal control (β = -1.897, P = 0.006); treatment control (β = -1.274, P = 0.046); and positive coping style (β = 4.872, P = 0.002) at the 3-month follow-up, and timeline (β = 2.769, P = 0.004) at the 1-month follow-up. Hypoglycemia fear and awareness were not significantly improved in the intervention group compared with the control group. No intervention-related adverse events were observed. CONCLUSIONS A CSM-based intervention program can modify illness perceptions to an extent and improve the positive coping style in patients with IAH.Impact statement: Nurses should conduct a CSM-based intervention program to help patients with IAH improve illness perceptions.
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Affiliation(s)
- Zhijia Shen
- Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Jianou Xu
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Wei Yin
- Affiliated hospital of Jiangsu University, Jiangsu, China
| | - Qiaoyan Liu
- Affiliated hospital of Jiangsu University, Jiangsu, China
| | - Minyu Fan
- Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Caifeng Luo
- School of Medicine, Jiangsu University, Jiangsu, People's Republic of China
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A parallel randomised controlled trial of the Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised self-care (HARPdoc). Nat Commun 2022; 13:2229. [PMID: 35484106 PMCID: PMC9050729 DOI: 10.1038/s41467-022-29488-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/18/2022] [Indexed: 02/02/2023] Open
Abstract
Impaired awareness of hypoglycaemia (IAH) is a major risk for severe hypoglycaemia in insulin treatment of type 1 diabetes (T1D). To explore the hypothesis that unhelpful health beliefs create barriers to regaining awareness, we conducted a multi-centre, randomised, parallel, two-arm trial (ClinicalTrials.gov NCT02940873) in adults with T1D and treatment-resistant IAH and severe hypoglycaemia, with blinded analysis of 12-month recall of severe hypoglycaemia at 12 and/or 24 months the primary outcome. Secondary outcomes included cognitive and emotional measures. Adults with T1D, IAH and severe hypoglycaemia despite structured education in insulin adjustment, +/- diabetes technologies, were randomised to the "Hypoglycaemia Awareness Restoration Programme despite optimised self-care" (HARPdoc, n = 49), a psychoeducation programme uniquely focussing on changing cognitive barriers to avoiding hypoglycaemia, or the evidence-based "Blood Glucose Awareness Training" (BGAT, n = 50), both delivered over six weeks. Median [IQR] severe hypoglycaemia at baseline was 5[2-12] per patient/year, 1[0-5] at 12 months and 0[0-2] at 24 months, with no superiority for HARPdoc (HARPdoc vs BGAT incident rate ratios [95% CI] 1.25[0.51, 3.09], p = 0.62 and 1.26[0.48, 3.35], p = 0.64 respectively), nor for changes in hypoglycaemia awareness scores or fear. Compared to BGAT, HARPdoc significantly reduced endorsement of unhelpful cognitions (Estimated Mean Difference for Attitudes to Awareness scores at 24 months, -2.07 [-3.37,-0.560], p = 0.01) and reduced scores for diabetes distress (-6.70[-12.50,-0.89], p = 0.02); depression (-1.86[-3.30, -0.43], p = 0.01) and anxiety (-1.89[-3.32, -0.47], p = 0.01). Despite positive impact on cognitive barriers around hypoglycaemia avoidance and on diabetes-related and general emotional distress scores, HARPdoc was not more effective than BGAT at reducing severe hypoglycaemia.
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Chapman K, Hughes AS, Bispham J, Leon C, Nguyen H, Wolf WA. Emergency Glucagon: a Focused Review of Psychosocial Experiences of Rescue Drugs for Type 1 Diabetes. Curr Diab Rep 2022; 22:189-197. [PMID: 35171447 DOI: 10.1007/s11892-021-01443-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to describe rescue glucagon types, safety, efficacy, and preferences, as well as to review articles regarding emergency glucagon usage, severe hypoglycemia, and the emotions of both phenomena. We conducted a review of current literature on glucagon usage and the emotional impact of severe hypoglycemia on people with diabetes (PwD) and the caregivers of people with type 1 diabetes (T1D). RECENT FINDINGS Minimal research exists pertaining to glucagon and severe hypoglycemic experiences in PwD, which is troubling considering the severity of risks and possible side effects. Recent articles described negative emotions such as fear, anxiety, stress, helplessness, shame, embarrassment, loneliness, frustration, hopefulness, and uncertainty surrounding glucagon usage. There is scarce research regarding PwD's emotions surrounding severe hypoglycemia and rescue glucagon use. Additional research is needed to investigate the emotions and feelings people with T1D and their caregivers' experience pertaining to severe hypoglycemia and emergency glucagon use.
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Affiliation(s)
- Katherine Chapman
- T1D Exchange, 11 Ave de Lafayette, 5th Floor, Boston, MA, 02111, USA.
| | - Allyson S Hughes
- Department of Primary Care, Ohio University, Heritage College of Osteopathic Medicine, Athens, OH, USA
| | | | - Carolina Leon
- T1D Exchange, 11 Ave de Lafayette, 5th Floor, Boston, MA, 02111, USA
| | - Huyen Nguyen
- T1D Exchange, 11 Ave de Lafayette, 5th Floor, Boston, MA, 02111, USA
| | - Wendy A Wolf
- T1D Exchange, 11 Ave de Lafayette, 5th Floor, Boston, MA, 02111, USA
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Stuckey HL, Desai U, King SB, Popadic L, Levinson W, Kirson NY, Hankosky ER, Mitchell B. The experience of a severe hypoglycaemic event from the perspective of people with diabetes and their caregivers: "What am I going to do?". Diabet Med 2022; 39:e14745. [PMID: 34797937 PMCID: PMC9299593 DOI: 10.1111/dme.14745] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/16/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
AIMS Among people with diabetes using insulin, severe hypoglycaemia (SH) can be a life-threatening complication, if untreated. The personal experiences during an SH event from the perspectives of people with diabetes and their caregivers are not well-characterized. This study assessed the perceptions of the event and the decision making processes of people with diabetes (T1D n = 36; T2D n = 24) and their caregivers during SH events. METHODS In-depth one-on-one telephone interviews were conducted with dyads of people with diabetes and caregivers in the United States (n = 120). An initial synopsis and inductive codebook schema were used to analyse the data with two independent coders (kappa = 0.87-0.89). Themes were developed from the codes, and codes were re-mapped to the themes. RESULTS Four themes were formed: (1) Caregivers scramble to do the right thing and support people with diabetes in treating SH; (2) Decision making capacity is impaired during an SH event, often a panicked time; (3) People learn to manage SH events through their own experiences and frequently make lifestyle changes to prevent and treat future events; and (4) Discussion with healthcare providers about SH, and particularly SH treatment, is limited. CONCLUSIONS SH events are stressful and often evoke emotional reactions that can impair decision making. Thus, advance treatment planning of SH events needs to occur. Much of the knowledge about SH treatment derives from prior experience rather than healthcare provider guidance, suggesting a need for healthcare providers to initiate proactive discussions about SH treatment.
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Maclean RH, Jacob P, Choudhary P, Heller SR, Toschi E, Kariyawasam D, Brooks A, Kendall M, de Zoysa N, Gonder-Frederick LA, Amiel SA. Hypoglycemia Subtypes in Type 1 Diabetes: An Exploration of the Hypoglycemia Fear Survey-II. Diabetes Care 2022; 45:538-546. [PMID: 35043151 PMCID: PMC8918257 DOI: 10.2337/dc21-1120] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/09/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Hypoglycemia Fear Survey-II (HFS-II) is a well-validated measure of fear of hypoglycemia in people with type 1 diabetes. The aim of this study was to explore the relationships between hypoglycemia worries, behaviors, and cognitive barriers to hypoglycemia avoidance and hypoglycemia awareness status, severe hypoglycemia, and HbA1c. RESEARCH DESIGN AND METHODS Participants with type 1 diabetes (n = 178), with the study population enriched for people at risk for severe hypoglycemia (49%), completed questionnaires for assessing hypoglycemia fear (HFS-II), hyperglycemia avoidance (Hyperglycemia Avoidance Scale [HAS]), diabetes distress (Problem Areas In Diabetes [PAID]), and cognitive barriers to hypoglycemia avoidance (Attitudes to Awareness of Hypoglycemia [A2A]). Exploratory factor analysis was applied to the HFS-II. We sought to establish clusters based on HFS-II, A2A, Gold, HAS, and PAID using k-means clustering. RESULTS Four HFS-II factors were identified: Sought Safety, Restricted Activity, Ran High, and Worry. While Sought Safety, Restricted Activity, and Worry increased with progressively impaired awareness and recurrent severe hypoglycemia, Ran High did not. With cluster analysis we outlined four clusters: two clusters with preserved hypoglycemia awareness were differentiated by low fear/low cognitive barriers to hypoglycemia avoidance (cluster 1) versus high fear and distress and increased Ran High behaviors (cluster 2). Two clusters with impaired hypoglycemia awareness were differentiated by low fear/high cognitive barriers (cluster 3) as well as high fear/low cognitive barriers (cluster 4). CONCLUSIONS This is the first study to define clusters of hypoglycemia experience by worry, behaviors, and cognitive barriers to hypoglycemia avoidance. The resulting subtypes may be important in understanding and treating problematic hypoglycemia.
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Affiliation(s)
- Rory H. Maclean
- Department of Diabetes, Faculty of Life Sciences, King’s College London, London, U.K
- King’s College Hospital NHS Foundation Trust, London, U.K
| | - Peter Jacob
- Department of Diabetes, Faculty of Life Sciences, King’s College London, London, U.K
- King’s College Hospital NHS Foundation Trust, London, U.K
| | - Pratik Choudhary
- Department of Diabetes, Faculty of Life Sciences, King’s College London, London, U.K
- University of Leicester, Leicester, U.K
| | | | - Elena Toschi
- Joslin Diabetes Centre, Harvard Medical School, Boston, MA
| | | | - Augustin Brooks
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, U.K
| | - Mike Kendall
- HARPdoc Patient Group, Department of Diabetes, King’s College London, London, U.K
| | | | - Linda A. Gonder-Frederick
- Center for Diabetes Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA
| | - Stephanie A. Amiel
- Department of Diabetes, Faculty of Life Sciences, King’s College London, London, U.K
- King’s College Hospital NHS Foundation Trust, London, U.K
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Huang J, Ding S, Xiong S, Liu Z. The Mediating Effects of Diabetes Distress, Anxiety, and Cognitive Fusion on the Association Between Neuroticism and Fear of Hypoglycemia in Patients With Type 2 Diabetes. Front Psychol 2021; 12:697051. [PMID: 34744863 PMCID: PMC8565853 DOI: 10.3389/fpsyg.2021.697051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: To explore the relationship between neuroticism and fear of hypoglycemia (FoH) among patients with type 2 diabetes (T2D), as well as the mediating effects of diabetes distress, anxiety, and cognitive fusion on the relationship between neuroticism and FoH. Methods: A total of 494 patients with T2D (39.9% females, n = 197) were analyzed using the neuroticism scale of the Eysenck Personality Questionnaire-Revised Short Scale (EPQ-RS), the Fear of Hypoglycemia-15 Scale (FH-15), the Diabetes Distress Scale (DDS), the Self-Rating Anxiety Scale (SAS), and the Cognitive Fusion Questionnaire (CFQ). The bootstrapping method was used to test the separate and parallel mediation models. Results: FoH was noted in 17.4% (n = 86) of patients. The correlations between neuroticism, diabetes distress, anxiety, cognitive fusion, and FoH were positive. Diabetes distress, anxiety, and cognitive fusion were significant mediators in the association between neuroticism and FoH in both separate and parallel mediation models. In the parallel mediation model, the mediating effect of anxiety was the highest, and the mediating effect of diabetes distress was the lowest, but no significant differences were found in the comparison of these three indirect effects. Conclusion: This study indicated that neuroticism not only directly affected FoH, but also indirectly influenced FoH via the increase of diabetes distress, anxiety, and cognitive fusion in patients with T2D. The results provide a theoretical basis for the development of intervention programs to ameliorate patients’ FoH directly and indirectly. Healthcare providers should be encouraged to develop appropriate programs based on improving diabetes distress, anxiety, and cognitive fusion to help patients with T2D improve FoH.
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Affiliation(s)
- Jing Huang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shenglan Ding
- Department of Nursing, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuyuan Xiong
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiping Liu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Naito A, Nwokolo M, Smith EL, de Zoysa N, Garrett C, Choudhary P, Amiel SA. Personality traits of alexithymia and perfectionism in impaired awareness of hypoglycemia in adults with type 1 diabetes - An exploratory study. J Psychosom Res 2021; 150:110634. [PMID: 34610494 PMCID: PMC8530191 DOI: 10.1016/j.jpsychores.2021.110634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Severe hypoglycemia complicates insulin therapy for type 1 diabetes, with impaired awareness of hypoglycemia (IAH) being a major risk factor. We explored associations between the personality traits, alexithymia and perfectionism, and cognitive barriers to hypoglycemia avoidance described in IAH, and evaluated their prevalence in people with and without IAH. METHODS Cross-sectional exploratory study. Ninety adults with type 1 diabetes, 54 hypoglycemia aware and 36 with IAH, completed validated questionnaires exploring alexithymia (Total Alexithymia Scale [TAS-20]) and perfectionism (Frost Multidimensional Perfectionism Scale [FMPS]); and cognitive barriers related to hypoglycemia avoidance (Attitudes to Awareness Questionnaire [A2A]. RESULTS Alexithymia and perfectionism scores correlated positively with cognitive barriers associated with IAH. Specifically, alexthymia scores correlated with the 'Hyperglycaemia Avoidance Prioritised' factor (r = 0.265; p = .02, n = 77) and the 'Asymptomatic Hypoglycemia Normalised' factor (r = 0.252-0.255; p = .03, n = 77). Perfectionism scores correlated with the 'Hyperglycaemia Avoidance Prioritised' factor (r = 0.525; p < .001, n = 66). Overall, IAH participants were significantly more likely to score at the high end for alexithymia (17.6% vs. 1.9%, p = .008, n = 87) and at the extreme ends (high and low) for perfectionism (69.0% vs. 40.0%, χ2 (1) = 6.24, p = .01, n = 77). CONCLUSION These novel data showing associations between alexithymia and perfectionism scores and maladaptive health beliefs in IAH suggest the intriguing possibility that personality traits may contribute to the risk of IAH, perhaps through their influence on incentives to avoid hypoglycemia. If confirmed, measuring such traits may help tailor early adjunctive psychological intervention to reduce hypoglycemia burden for people with IAH.
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Affiliation(s)
- Anna Naito
- Diabetes Research Group, Faculty of Life Sciences & Medicine, King's College London, London, UK,Diabetes Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Munachiso Nwokolo
- Diabetes Research Group, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Emma L. Smith
- Diabetes Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Nicole de Zoysa
- Diabetes Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Christopher Garrett
- Diabetes and Psychiatry Research Group, Department of Psychological Medicine, King's College London, London, UK,Diabetes and Metabolism Department, Bart's Health NHS Trust, London, UK
| | - Pratik Choudhary
- Diabetes Research Group, Faculty of Life Sciences & Medicine, King's College London, London, UK,Diabetes Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephanie A. Amiel
- Diabetes Research Group, Faculty of Life Sciences & Medicine, King's College London, London, UK,Diabetes Department, King's College Hospital NHS Foundation Trust, London, UK,Corresponding author at: Diabetes Research Group, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
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Factors associated with work ability in adults with diabetes. Appl Nurs Res 2021; 61:151478. [PMID: 34544572 DOI: 10.1016/j.apnr.2021.151478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022]
Abstract
AIMS The aims of this study were to explore associations between clinical and diabetes-related factors with work ability in a sample of working adults with diabetes. BACKGROUND Adults with diabetes may face challenges in the workplace, including managing their diabetes and overall physical and mental health. METHODS This was a cross-sectional design with a sample of 101 working adults. Subjects completed valid and reliable surveys assessing depressive symptoms, diabetes self-care, fear of hypoglycemia, diabetes distress, cardiovascular health using American Heart Association's Life's Simple 7 (range 0-7) and work ability. Factors significantly associated with work ability at bivariate level were included in linear and logistic regression. RESULTS The majority of the sample was female (65%) (mean age 54.1 ± 10.5), White (74%), non-Hispanic (93%), worked full-time (65%) and had type 2 diabetes (87%) (mean duration 12.4 ± 9.5 years). The majority (55%) had low diabetes distress, but 24% had high distress and 28% had depressive symptoms. The sample achieved 2.5 ± 1.4 ideal AHA heart health indices and 33% rated their work ability as excellent. In linear regression higher depressive scores were associated with lower work ability scores (b = -0.45, p = .002). In logistic regression, scores on heart health (OR = 1.4; 95%CI:1.0-1.9, p = .03) and diabetes distress (OR = 0.6, 95%CI:0.4-0.9, p = .048) were significantly associated with work ability at its best. CONCLUSION Both cardiovascular and psychological health may impact work ability in adults with diabetes. Routinely screening for diabetes distress and depression while also promoting ideal cardiovascular health may improve overall health and work ability in this population.
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Blissett DB, Attvall S, Hellmund RA. Analysis Estimating the Potential Cost Impact of Utilizing Flash Glucose Monitoring with Optional Alarms in Swedish Adults with Diabetes with Impaired Awareness of Hypoglycaemia, Using Intensive Insulin. Diabetes Ther 2021; 12:2179-2193. [PMID: 34232483 PMCID: PMC8342735 DOI: 10.1007/s13300-021-01099-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/10/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The objective of this analysis was to estimate the costs associated with using flash glucose monitoring with optional alarms as a replacement for either traditional continuous glucose monitoring (CGM) or routine self-monitoring of blood glucose (SMBG) in adults with diabetes and impaired awareness of hypoglycaemia (IAH) who use intensified insulin therapy, from a Swedish payer perspective, applying assumptions to simulate hypothetical scenarios. METHODS A simple two-state cohort Markov model was used to calculate the cost per patient treated over a 3-year period, capturing the risk of severe hypoglycaemic events requiring medical assistance and non-adherence using quarterly Markov cycles. The costs considered were those for glucose monitoring and resource use to treat severe hypoglycaemic events. Cost inputs were sourced from Swedish price lists, manufacturer data and resource use reported in the control arm of the HypoDE study. Targeted literature searches were run in PubMed to source the clinical inputs. Uncertainty in the model was considered through one-way sensitivity analysis and scenario analysis. RESULTS Over 3 years, flash monitoring with optional alarms resulted in potential cost-savings of Swedish krona (SEK) 7708 and SEK 69,908 per patient when compared to routine SMBG or CGM respectively. Sensitivity and scenario analyses were largely supportive of this conclusion with respect to SMBG, and large cost-savings were consistent across all sensitivity and scenario analyses with respect to CGM. CONCLUSION Utilizing flash monitoring with optional alarms is potentially a cost-saving treatment strategy compared to routine SMBG or traditional CGM in adults with diabetes using intensive insulin and IAH from a Swedish payer perspective. Future studies in the IAH population will help to assess more precisely the relative cost impact of flash glucose monitoring with optional alarms compared with SMBG and traditional CGM.
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Affiliation(s)
| | - Stig Attvall
- Diabetes, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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27
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Chatwin H, Broadley M, Valdersdorf Jensen M, Hendrieckx C, Carlton J, Heller S, Amiel S, de Galan B, Hermanns N, Finke-Groene K, Speight J, Pouwer F. 'Never again will I be carefree': a qualitative study of the impact of hypoglycemia on quality of life among adults with type 1 diabetes. BMJ Open Diabetes Res Care 2021; 9:e002322. [PMID: 34400465 PMCID: PMC8370551 DOI: 10.1136/bmjdrc-2021-002322] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/17/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Achieving glycemic targets and optimizing quality of life (QoL) are important goals of type 1 diabetes care. Hypoglycemia is a common barrier to achieving targets and can be associated with significant distress. However, the impact of hypoglycemia on QoL is not fully understood. The aim of this study was to explore how adults with type 1 diabetes are impacted by hypoglycemia in areas of life that are important to their overall QoL. RESEARCH DESIGN AND METHODS Participants responded to a web-based qualitative survey involving a novel 'Wheel of Life' activity. Responses were analyzed using reflexive thematic analysis. RESULTS The final sample included 219 adults with type 1 diabetes from Denmark, Germany, the Netherlands, and the UK. They had a mean±SD age of 39±13 years and diabetes duration of 20±14 years. Participants identified eight areas of life important to their overall QoL, including relationships and social life, work and studies, leisure and physical activity, everyday life, sleep, sex life, physical health, and mental health. Participants reported emotional, behavioral, cognitive, and social impacts of hypoglycemia within domains. Across domains, participants described interruptions, limited participation in activities, exhaustion, fear of hypoglycemia, compensatory strategies to prevent hypoglycemia, and reduced spontaneity. CONCLUSIONS The findings emphasize the profound impact of hypoglycemia on QoL and diabetes self-care behaviors. Diabetes services should be aware of and address the burden of hypoglycemia to provide person-centered care. Clinicians could ask individuals how hypoglycemia affects important areas of their lives to better understand the personal impact and develop tailored management plans.
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Affiliation(s)
- Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Bastiaan de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | | | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Research Unit, Steno Diabetes Center Odense, Odense, Denmark
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Polonsky WH, Fortmann AL, Price D, Fisher L. "Hyperglycemia aversiveness": Investigating an overlooked problem among adults with type 1 diabetes. J Diabetes Complications 2021; 35:107925. [PMID: 33836966 DOI: 10.1016/j.jdiacomp.2021.107925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the problem of adults with type 1 diabetes (T1D) who purposefully keep their glucose levels low, and to explore contributors to, and possible impact of, this potentially dangerous phenomenon. METHODS We developed three self-report items as a means to identify individuals who endorse a consistent preference for hypoglycemia over hyperglycemia ("Hyperglycemia Aversives"). In a large T1D survey (n = 219), validated measures of well-being, emotional distress and hypoglycemic awareness, and glycemic metrics derived from the past 14-day period, were used to examine whether Hyperglycemia Aversives could be characterized as a distinct group. RESULTS Hyperglycemia Aversives comprised 16.4% of the sample. This unique group demonstrated significantly higher mean %TIR (71.6% vs. 63.6%) and %TBR (5.1% vs. 2.2%), lower mean %TAR > 250 mg/dL (6.0% vs. 10.1%), and higher rates of impaired hypoglycemic awareness and recurrent severe hypoglycemia episodes than the remaining study sample ("Non-Aversives") (all ps < 0.01). The two groups did not demonstrate significant differences on psychosocial outcomes. CONCLUSIONS We identified a group of T1D adults reporting a consistent preference for hypoglycemia over hyperglycemia. These individuals achieve significantly greater %TIR and less %TAR, but at the cost of greater %TBR and more frequent severe hypoglycemia episodes.
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Affiliation(s)
- W H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, United States of America; Department of Medicine, University of California, San Diego, CA, United States of America.
| | - A L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, CA, United States of America
| | - D Price
- Dexcom, Inc., San Diego, CA, United States of America
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
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Wang Y, Zeng Z, Ding J, Yuan R, Wang R, Zhang Y, Bai L, Yu H, Tang J. Fear of hypoglycaemia among patients with type 2 diabetes mellitus: a cross-sectional study. Sci Rep 2021; 11:7971. [PMID: 33846441 PMCID: PMC8042064 DOI: 10.1038/s41598-021-86954-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
To investigate the fear of hypoglycaemia in patients with type 2 diabetes mellitus (T2DM), to identify factors related to this fear, and thus to provide evidence for clinical assessment. A total of 385 patients with T2DM who were admitted to the departments of endocrinology in five tertiary grade-A hospitals in Chongqing, China were included in this study. A questionnaire for general information and a Chinese version of Hypoglycemia Fear Survey (HFS) were used to collect the data. The average total score on the HFS was 71.67 ± 17.06 (HFS-W was 38.15 ± 10.57; HFS-B was 33.52 ± 9.54).The three items with the highest average score for HFS-W were not recognising low blood glucose (BG), not having food available, experiencing a hypoglycaemic episode alone, and for HFS-B were eating large amount of snacks, measuring BG six or more times per day, and keeping BG > 150 mmol/L. Regressions showed that number of hospitalisations for T2DM, receiving health education on diabetes, age and hypoglycaemia history because of T2DM were associated with fear of hypoglycaemia (all p < 0.05). Fear of hypoglycaemia in hospitalised patients with T2DM was strongly associated with diabetes health education, hospitalisation for diabetes, age, and hypoglycaemia history. Medical professionals should attach importance to the specific psychological interventions, health education on diabetes and the early prevention of hypoglycaemia or diabetic complications for patients with T2DM to reduce the fear of hypoglycaemia and improve their health status.
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Affiliation(s)
- Yanhao Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, China.,Department of Orthodontics, Xi'an Jiaotong University School of Stomatology, 98# Xiwu Road, Xi'an, 710000, Shaanxi, China.,College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Zihuan Zeng
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China
| | - Jie Ding
- School of Foreign Languages, Chongqing Medical University, Chongqing, China
| | - Ruizhu Yuan
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China
| | - Ruiding Wang
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China
| | - You Zhang
- School of Foreign Languages, Chongqing Medical University, Chongqing, China
| | - Liyao Bai
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China
| | - Huan Yu
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China
| | - Jiao Tang
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China.
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Chatwin H, Broadley M, Speight J, Cantrell A, Sutton A, Heller S, de Galan B, Hendrieckx C, Pouwer F. The impact of hypoglycaemia on quality of life outcomes among adults with type 1 diabetes: A systematic review. Diabetes Res Clin Pract 2021; 174:108752. [PMID: 33722700 DOI: 10.1016/j.diabres.2021.108752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/15/2021] [Accepted: 03/05/2021] [Indexed: 01/20/2023]
Abstract
Hypoglycaemia is a common barrier to optimal glycaemic management and often feared among adults with type 1 diabetes. The aim of this systematic review was to summarize current evidence regarding the impact of hypoglycaemia on quality of life (QoL) and related outcomes. Electronic searches of MEDLINE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were conducted. Peer-reviewed empirical studies investigating the relationship between hypoglycaemia and QoL were eligible for inclusion. Thirty studies met the inclusion criteria. Extracted data was summarized in a narrative synthesis according to Synthesis Without Meta-Analysis guidelines. None of the studies examined the impact of hypoglycaemia on general QoL. There was no association between hypoglycaemia and diabetes-specific QoL in four of the 30 studies. Severe hypoglycaemia was associated with greater fear of hypoglycaemia and diabetes distress, and lower general emotional well-being, but not with depression, anxiety, or health status. Self-treated hypoglycaemia was associated with greater fear of hypoglycaemia. With the exception of fear of hypoglycaemia, this review shows mixed associations between hypoglycaemia and psychological outcomes. Further research is needed to investigate the impact of hypoglycaemia on other domains of QoL.
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Affiliation(s)
- Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark; School of Psychology, Deakin University, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
| | - Anna Cantrell
- Information Resources Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Anthea Sutton
- Information Resources Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Bastiaan de Galan
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark; School of Psychology, Deakin University, Geelong, Australia; Steno Diabetes Center Odense, Odense, Denmark
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Henriksen MM, Andersen HU, Thorsteinsson B, Pedersen-Bjergaard U. Effects of continuous glucose monitor-recorded nocturnal hypoglycaemia on quality of life and mood during daily life in type 1 diabetes. Diabetologia 2021; 64:903-913. [PMID: 33443591 DOI: 10.1007/s00125-020-05360-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS The aim of this work was to assess the effect of spontaneous nocturnal hypoglycaemia on quality of life and mood during subsequent days in type 1 diabetes. METHODS A total of 153 people with type 1 diabetes participated in 6 days of blinded continuous glucose monitoring while documenting hypoglycaemic symptoms, quality of life and mood, daily. Hypoglycaemia was defined by interstitial glucose ≤3.9 mmol/l (IG3.9) and ≤ 3.0 mmol/l (IG3.0) for ≥15 min and was classified as asymptomatic if no hypoglycaemic symptoms were reported. RESULTS Self-estimated quality of life assessed by the EQ-5D VAS (but not by the WHO Well-Being Index) was higher the day after asymptomatic (but not after symptomatic) hypoglycaemic nights, as compared with non-hypoglycaemic nights (IG3.9, p = 0.021; IG3.0, p = 0.048). The effect increased with lower glucose nadir and longer duration of nocturnal hypoglycaemia (IG3.9, p = 0.03). The finding was confined to participants with impaired hypoglycaemia awareness. There was no effect of nocturnal hypoglycaemia on mood or self-estimated effectiveness at work the following day. CONCLUSIONS/INTERPRETATION Individuals with type 1 diabetes and impaired hypoglycaemia awareness reported higher quality of life on days preceded by nights with asymptomatic (but not symptomatic) hypoglycaemia. The effect was amplified by lower glucose nadir and longer duration of the episodes and may help explain resistance to implementation of interventions to reduce hypoglycaemia in many people with impaired hypoglycaemia awareness.
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Affiliation(s)
- Marie M Henriksen
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark.
| | | | - Birger Thorsteinsson
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Nwokolo M, Amiel SA, O'Daly O, Macdonald IA, Zelaya FO, Choudhary P. Restoration of Hypoglycemia Awareness Alters Brain Activity in Type 1 Diabetes. Diabetes Care 2021; 44:533-540. [PMID: 33328282 DOI: 10.2337/dc20-1250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Impaired awareness of hypoglycemia (IAH) in type 1 diabetes (T1D) is a major risk factor for severe hypoglycemia (SH) and is associated with atypical responses to hypoglycemia in brain regions involved in arousal, decision making, and memory. Whether restoration of hypoglycemia awareness alters these responses is unknown. We sought to investigate the impact of awareness restoration on brain responses to hypoglycemia. RESEARCH DESIGN AND METHODS Twelve adults with T1D and IAH underwent pseudocontinuous arterial spin labeling functional MRI during a hypoglycemic clamp (5-2.6 mmol/L) before and after a hypoglycemia avoidance program of structured education (Dose Adjustment for Normal Eating), specialist support, and sensor-augmented pump therapy (Medtronic MiniMed 640G). Hypoglycemic cerebral blood flow (CBF) responses were compared pre- and postintervention using predefined region-of-interest analysis of the thalamus, anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), and hippocampus. RESULTS Postintervention, Gold and Clarke scores fell (6.0 ± 1.0 to 4.0 ± 1.6, P = 0.0002, and 5.7 ± 1.7 to 3.4 ± 1.8, P = 0.0008, respectively), SH rates reduced (1.5 ± 2 to 0.3 ± 0.5 episodes per year, P = 0.03), hypoglycemic symptom scores increased (18.8 ± 6.3 to 27.3 ± 12.7, P = 0.02), and epinephrine responses did not change (P = 0.2). Postintervention, hypoglycemia induced greater increases in ACC CBF (P = 0.01, peak voxel coordinates [6, 40, -2]), while thalamic and OFC activity did not change. CONCLUSIONS Increased blood flow is seen within brain pathways involved in internal self-awareness and decision making (ACC) after restoration of hypoglycemia awareness, suggesting partial recovery of brain responses lost in IAH. Resistance of frontothalamic networks, involved in arousal and emotion processing, may explain why not all individuals with IAH achieve awareness restoration with education and technology alone.
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Affiliation(s)
- Munachiso Nwokolo
- Department of Diabetes, School of Life Course Sciences, King's College London, London, U.K. .,King's College Hospital NHS Foundation Trust, London, U.K
| | - Stephanie A Amiel
- Department of Diabetes, School of Life Course Sciences, King's College London, London, U.K.,King's College Hospital NHS Foundation Trust, London, U.K
| | - Owen O'Daly
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, U.K
| | - Ian A Macdonald
- School of Life Sciences, MRC-Arthritis Research UK Centre of Excellence in Musculoskeletal Ageing, Nottingham University Medical School, Queen's Medical Centre, Nottingham, U.K
| | - Fernando O Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, U.K
| | - Pratik Choudhary
- Department of Diabetes, School of Life Course Sciences, King's College London, London, U.K.,King's College Hospital NHS Foundation Trust, London, U.K
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Mostafavi F, Alavijeh FZ, Salahshouri A, Mahaki B. The psychosocial barriers to medication adherence of patients with type 2 diabetes: a qualitative study. Biopsychosoc Med 2021; 15:1. [PMID: 33461565 PMCID: PMC7812642 DOI: 10.1186/s13030-020-00202-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022] Open
Abstract
Background The adherence of diabetic patients to their medication regimen is associated with many psychosocial factors that are still unknown. Therefore, the present study aims to identify the psychosocial barriers to medication adherence of patients with type2 diabetes (T2D). Methodology This descriptive qualitative study was done in Isfahan, Iran by conducting in-depth unstructured interviews with 23 purposively selected patients with T2D and 10 healthcare providers (HCPs). The participants were interviewed face-to-face between November 2017 and June 2018 at the patient’s home, a Health Care Center, or at the diabetes clinic. Data analysis was performed using MAXQDA-10 software and the conventional content analysis. Results The analysis of the data led to six categories of perceived psychosocial barriers: 1) fear, concern and distress, 2) exhaustion and burnout, 3) the children’s issues being the priority, 4) poor financial support, 5) communication challenges, and 6) poor work conditions. Conclusions This study identified some of the psychosocial barriers to medication adherence of patients with T2D, which will be of great help to researchers and HCPs in designing and implementing effective interventions to overcome these barriers and change patient self-care behaviors and increase their medication adherence.
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Affiliation(s)
- Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Salahshouri
- Department of Health Education and Promotion, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 61357 - 15751, Iran.
| | - Behzad Mahaki
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Mujahid O, Contreras I, Vehi J. Machine Learning Techniques for Hypoglycemia Prediction: Trends and Challenges. SENSORS (BASEL, SWITZERLAND) 2021; 21:E546. [PMID: 33466659 PMCID: PMC7828835 DOI: 10.3390/s21020546] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
(1) Background: the use of machine learning techniques for the purpose of anticipating hypoglycemia has increased considerably in the past few years. Hypoglycemia is the drop in blood glucose below critical levels in diabetic patients. This may cause loss of cognitive ability, seizures, and in extreme cases, death. In almost half of all the severe cases, hypoglycemia arrives unannounced and is essentially asymptomatic. The inability of a diabetic patient to anticipate and intervene the occurrence of a hypoglycemic event often results in crisis. Hence, the prediction of hypoglycemia is a vital step in improving the life quality of a diabetic patient. The objective of this paper is to review work performed in the domain of hypoglycemia prediction by using machine learning and also to explore the latest trends and challenges that the researchers face in this area; (2) Methods: literature obtained from PubMed and Google Scholar was reviewed. Manuscripts from the last five years were searched for this purpose. A total of 903 papers were initially selected of which 57 papers were eventually shortlisted for detailed review; (3) Results: a thorough dissection of the shortlisted manuscripts provided an interesting split between the works based on two categories: hypoglycemia prediction and hypoglycemia detection. The entire review was carried out keeping this categorical distinction in perspective while providing a thorough overview of the machine learning approaches used to anticipate hypoglycemia, the type of training data, and the prediction horizon.
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Affiliation(s)
- Omer Mujahid
- Model Identification and Control Laboratory, Institut d’Informatica i Applicacions, Universitat de Girona, 17003 Girona, Spain; (O.M.); (I.C.)
| | - Ivan Contreras
- Model Identification and Control Laboratory, Institut d’Informatica i Applicacions, Universitat de Girona, 17003 Girona, Spain; (O.M.); (I.C.)
| | - Josep Vehi
- Model Identification and Control Laboratory, Institut d’Informatica i Applicacions, Universitat de Girona, 17003 Girona, Spain; (O.M.); (I.C.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 17003 Girona, Spain
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Roze S, Isitt JJ, Smith-Palmer J, Lynch P, Klinkenbijl B, Zammit G, Benhamou PY. Long-Term Cost-Effectiveness the Dexcom G6 Real-Time Continuous Glucose Monitoring System Compared with Self-Monitoring of Blood Glucose in People with Type 1 Diabetes in France. Diabetes Ther 2021; 12:235-246. [PMID: 33165838 PMCID: PMC7651823 DOI: 10.1007/s13300-020-00959-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The aim was to determine the long-term cost-effectiveness of the Dexcom G6 real-time continuous glucose monitoring (RT-CGM) system versus self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes (T1D) in France. METHODS The analysis was performed using the IQVIA Core Diabetes Model and utilized clinical input data from the DIAMOND clinical trial in adults with T1D. Simulated patients were assumed to have a mean baseline HbA1c of 8.6%, and those in the RT-CGM arm were assumed to have a HbA1c reduction of 1.0% compared with 0.4% in the SMBG arm. A quality of life (QoL) benefit associated with a reduced fear of hypoglycemia (FoH) and elimination of the requirement for fingerstick testing in the RT-CGM arm was also applied. RESULTS The G6 RT-CGM system was associated with an incremental gain in quality-adjusted life expectancy of 1.38 quality-adjusted life years (QALYs) compared with SMBG (10.64 QALYs versus 9.23 QALYs). Total mean lifetime costs were 21,087 euros higher with RT-CGM (148,077 euros versus 126,990 euros), resulting in an incremental cost-effectiveness ratio of 15,285 euros per QALY gained. CONCLUSIONS In France, based on a willingness-to-pay threshold of 50,000 euros per QALY gained, the use of the G6 RT-CGM system is cost-effective relative to SMBG for adults with long-standing T1D, driven primarily by improved glycemic control and the QoL benefit associated with reduced FoH and elimination of the requirement for fingerstick testing.
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Affiliation(s)
| | | | | | | | | | | | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble Alpes University Hospital, Grenoble, France
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Abraham SB, Arunachalam S, Zhong A, Agrawal P, Cohen O, McMahon CM. Improved Real-World Glycemic Control With Continuous Glucose Monitoring System Predictive Alerts. J Diabetes Sci Technol 2021; 15:91-97. [PMID: 31272204 PMCID: PMC7783013 DOI: 10.1177/1932296819859334] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Most standalone real-time continuous glucose monitoring (RT-CGM) systems provide predictive low and high sensor glucose (SG) threshold alerts. The durations and risk of low and high SG excursions following Guardian™ Connect CGM system predictive threshold alerts were evaluated. METHODS Continuous glucose monitoring system data uploaded between January 2, 2017 and May 22, 2018 by 3133 individuals using multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) therapy were deidentified and retrospectively analyzed. Glucose excursions were defined as SG values that went beyond a preset low or high SG threshold for ≥15 minutes. For a control group, thresholds were based on the median of the low SG threshold limit (70 mg/dL) and the high SG threshold limit (210 mg/dL) preset by all system users. During periods when alerts were not enabled, timestamps were identified when a predictive alert would have been triggered. The time before low horizon was 17.5 minutes and the time before high horizon was 15 minutes, of all users who enabled alerts. Excursions occurring after a low SG or high SG predictive alert were segmented into prevented, ≤20, 20-60, and >60 minutes. RESULTS Excursions were prevented after 59% and 39% of low and high SG predictive alerts, respectively. The risk of a low or high excursion occurring was 1.9 (P < 0.001, 95% CI, 1.88-1.93) and 3.3 (P < 0.001, 95% CI, 3.20-3.30) times greater, respectively, when alerts were not enabled. CONCLUSIONS The predictive alerts of the RT-CGM system under study can help individuals living with diabetes prevent some real-world low and high SG excursions. This can be especially important for those unable to reach or maintain glycemic control with basic RT-CGM or CSII therapy.
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Affiliation(s)
| | | | | | | | | | - Chantal M. McMahon
- Medtronic, Northridge, CA, USA
- Chantal M. McMahon, PhD, Medtronic, 18000 Devonshire Street, Northridge, CA 91325, USA.
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Tshabalala AM, Ajidahun AT, Mkhabela T, Bapela P, Majumane C, Msimango T. Prevalence and factors associated with fear of hypoglycaemia among adults with Type 1 diabetes mellitus at an academic hospital in South Africa. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Liu J, Bispham J, Fan L, Poon JL, Hughes A, Mcauliffe-Fogarty A, Varnado O, Mitchell B. Factors associated with fear of hypoglycaemia among the T1D Exchange Glu population in a cross-sectional online survey. BMJ Open 2020; 10:e038462. [PMID: 32895285 PMCID: PMC7476480 DOI: 10.1136/bmjopen-2020-038462] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Fear of hypoglycaemia (FoH) has been associated with suboptimal diabetes management and health outcomes. This study investigated factors associated with behavioural and emotional aspects of FoH among adults living with type 1 diabetes (T1D) mellitus. DESIGN Cross-sectional study. SETTING Online survey hosted on T1D Exchange Glu, an online community for patients living with T1D mellitus. MEASURES The Hypoglycaemia Fear Survey II-short form and the Hypoglycaemic Attitudes and Behaviour Scale were used to assess FoH. Multivariable regressions were performed on assessment scores. RESULTS The study included 494 participants (mean±SD age 43.9±12.2 years, duration of T1D mellitus 16.6±16.8 years, self-reported glycosylated hemoglobin (HbA1c) 6.9%±0.8% (52±9 mmol/mol)), 63% men, 89% on insulin pump, 25% experienced a severe hypoglycaemic event in the last 6 months. Multivariable regression analyses showed higher anxiety, depression severity and diabetes distress were independently associated with FoH (all p<0.01). Longer diabetes duration was associated with lower FoH (p<0.01). Past experience with severe hypoglycaemia was associated with higher worry of hypoglycaemia (p<0.01) but not avoidance behaviour (ns). CONCLUSIONS These results highlighted the multifaceted nature of FoH, which warrants further discussion between providers and patients to uncover drivers of and actions required to reduce FoH and improve patient care and outcomes.
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Affiliation(s)
- Jingwen Liu
- Patient-Centered Research, T1D Exchange, Boston, Massachusetts, USA
| | - Jeoffrey Bispham
- Patient-Centered Research, T1D Exchange, Boston, Massachusetts, USA
| | - Ludi Fan
- Lilly Diabetes, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Jiat-Ling Poon
- Lilly Diabetes, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Allyson Hughes
- Patient-Centered Research, T1D Exchange, Boston, Massachusetts, USA
| | | | - Oralee Varnado
- Lilly Diabetes, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Beth Mitchell
- Lilly Diabetes, Eli Lilly and Company, Indianapolis, Indiana, USA
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Lebel S, Mutsaers B, Tomei C, Leclair CS, Jones G, Petricone-Westwood D, Rutkowski N, Ta V, Trudel G, Laflamme SZ, Lavigne AA, Dinkel A. Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates. PLoS One 2020; 15:e0234124. [PMID: 32716932 PMCID: PMC7384626 DOI: 10.1371/journal.pone.0234124] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses. METHODS We used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained. RESULTS There were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes 'excessive.' The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features. CONCLUSIONS The concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.
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Affiliation(s)
- Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christina Tomei
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Georden Jones
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicole Rutkowski
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Viviane Ta
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Geneviève Trudel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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Rechenberg K, Griggs S, Jeon S, Redeker N, Yaggi HK, Grey M. Sleep and Glycemia in Youth With Type 1 Diabetes. J Pediatr Health Care 2020; 34:315-324. [PMID: 32171612 PMCID: PMC7311270 DOI: 10.1016/j.pedhc.2019.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Short sleep duration and quality are problems for many youth, and are associated with difficulties in executive function. Our purpose was to describe subjective and objective sleep characteristics and their associations with executive function, stress and coping, adjustment, and self-management in youth with type 1 diabetes (T1D). METHOD Youth with T1D (N = 40; mean age, 13.4 ± 1.9 years; 60% female; 77.1% non-Hispanic white; diabetes duration, 7.1 ± 4.6 years; and hemoglobin A1c, 8.2 ± 1.2%) wore an actigraph and a continuous glucose monitor for 3-7 days and completed questionnaires. Descriptive and bivariate analyses were conducted. RESULTS Sleep variability was associated with stress and depressive symptoms, as well as more glucose variability. Consistent rest-activity rhythm timing was associated with fewer trait anxiety symptoms. Robust rhythms were associated with better diabetes self-management. DISCUSSION Providers should routinely assess sleep habits in youth, especially those with T1D. Improving consistency in sleep timing and sleep duration may be a potential therapeutic target to improve diabetes clinical outcomes.
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de Galan BE, McCrimmon RJ, Ibberson M, Heller SR, Choudhary P, Pouwer F, Speight J, Carlton J, Pieber TR, Rosilio M, Tack CJ, Müllenborn M. Reducing the burden of hypoglycaemia in people with diabetes through increased understanding: design of the Hypoglycaemia REdefining SOLutions for better liVEs (Hypo-RESOLVE) project. Diabet Med 2020; 37:1066-1073. [PMID: 31970814 PMCID: PMC7317819 DOI: 10.1111/dme.14240] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypoglycaemia is the most frequent complication of treatment with insulin or insulin secretagogues in people with diabetes. Severe hypoglycaemia, i.e. an event requiring external help because of cognitive dysfunction, is associated with a higher risk of adverse cardiovascular outcomes and all-cause mortality, but underlying mechanism(s) are poorly understood. There is also a gap in the understanding of the clinical, psychological and health economic impact of 'non-severe' hypoglycaemia and the glucose level below which hypoglycaemia causes harm. AIM To increase understanding of hypoglycaemia by addressing the above issues over a 4-year period. METHODS Hypo-RESOLVE is structured across eight work packages, each with a distinct focus. We will construct a large, sustainable database including hypoglycaemia data from >100 clinical trials to examine predictors of hypoglycaemia and establish glucose threshold(s) below which hypoglycaemia constitutes a risk for adverse biomedical and psychological outcomes, and increases healthcare costs. We will also investigate the mechanism(s) underlying the antecedents and consequences of hypoglycaemia, the significance of glucose sensor-detected hypoglycaemia, the impact of hypoglycaemia in families, and the costs of hypoglycaemia for healthcare systems. RESULTS The outcomes of Hypo-RESOLVE will inform evidence-based definitions regarding the classification of hypoglycaemia in diabetes for use in daily clinical practice, future clinical trials and as a benchmark for comparing glucose-lowering interventions and strategies across trials. Stakeholders will be engaged to achieve broadly adopted agreement. CONCLUSION Hypo-RESOLVE will advance our understanding and refine the classification of hypoglycaemia, with the ultimate aim being to alleviate the burden and consequences of hypoglycaemia in people with diabetes.
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Affiliation(s)
- B. E. de Galan
- Radboud University Medical CentreNijmegenThe Netherlands
- Maastricht University Medical Centre+MaastrichtThe Netherlands
| | | | - M. Ibberson
- Swiss Institute of BioinformaticsLausanneSwitzerland
| | | | | | - F. Pouwer
- University of Southern DenmarkOdenseDenmark
- Deakin UniversityGeelongAustralia
| | - J. Speight
- University of Southern DenmarkOdenseDenmark
- Deakin UniversityGeelongAustralia
- Australian Centre for Behavioural Research in DiabetesMelbourneAustralia
| | | | | | - M. Rosilio
- Lilly FranceNeuilly‐sur‐Seine CedexFrance
| | - C. J. Tack
- Radboud University Medical CentreNijmegenThe Netherlands
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Toth M, Jokić-Begić N. Psychological contribution to understanding the nature of dry eye disease: a cross-sectional study of anxiety sensitivity and dry eyes. Health Psychol Behav Med 2020; 8:202-219. [PMID: 34040868 PMCID: PMC8114394 DOI: 10.1080/21642850.2020.1770093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/11/2020] [Indexed: 11/30/2022] Open
Abstract
Dry eye disease (DED) represents a common health problem in the general population. Previous studies have demonstrated that the subjective symptoms of dry eye are associated with several psychological factors, including depression, anxiety and post-traumatic stress disorder. However, there is a lack of empirical information about the mechanisms underlying the relationships between DED and various psychological symptoms. In light of emerging evidence of its trans-diagnostic nature, anxiety sensitivity (i.e. AS) represents one promising factor for further understanding DED. The present study aimed to explore whether anxiety sensitivity plays a role in the perception of DED symptoms in a community-based sample of adults aged 20-89 years (N = 381; M = 39.72, SD = 12.6). A dry ocular surface was reported by 22.8% of the participants. As expected, women more often reported symptoms of dry eye that could be categorized as moderate to severe. The findings demonstrated that AS, and the AS-psychological concerns dimension in particular, predict the intensity of dry eye symptoms above and beyond depressive and anxiety symptoms. These findings add to a growing body of work underscoring the relevance of AS in increasing the risk of chronic medical conditions.
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Affiliation(s)
- Marko Toth
- Department of Optometry, University of Applied Sciences Velika Gorica, Velika Gorica, Croatia
| | - Nataša Jokić-Begić
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
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Farrell CM, McNeilly AD, Fournier P, Jones T, Hapca SM, West D, McCrimmon RJ. A randomised controlled study of high intensity exercise as a dishabituating stimulus to improve hypoglycaemia awareness in people with type 1 diabetes: a proof-of-concept study. Diabetologia 2020; 63:853-863. [PMID: 31942669 PMCID: PMC7054230 DOI: 10.1007/s00125-019-05076-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/25/2019] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS Approximately 25% of people with type 1 diabetes have suppressed counterregulatory hormonal and symptomatic responses to insulin-induced hypoglycaemia, which renders them at increased risk of severe, disabling hypoglycaemia. This is called impaired awareness of hypoglycaemia (IAH), the cause of which is unknown. We recently proposed that IAH develops through habituation, a form of adaptive memory to preceding hypoglycaemia. Consistent with this hypothesis, we demonstrated restoration of defective counterregulatory hormonal responses to hypoglycaemia (referred to as dishabituation) in a rodent model of IAH following introduction of a novel stress stimulus (high intensity training [HIT]). In this proof-of-concept study we sought to further test this hypothesis by examining whether a single episode of HIT would amplify counterregulatory responses to subsequent hypoglycaemia in people with type 1 diabetes who had IAH (assessed by Gold score ≥4, modified Clarke score ≥4 or Dose Adjustment For Normal Eating (DAFNE) hypoglycaemia awareness rating 2 or 3). The primary outcome was the difference in adrenaline response to hypoglycaemia following both a single episode of HIT and rest. METHODS In this randomised, crossover study 12 participants aged between 18 and 55 years with type 1 diabetes for ≥5 years and an HbA1c <75 mmol/mol (9%) were recruited. Individuals were randomised using computer generated block randomisation to start with one episode of HIT (4 × 30 s cycle sprints [2 min recovery] at 150% of maximum wattage achieved during [Formula: see text] assessment) or rest (control). The following day they underwent a 90 min hyperinsulinaemic-hypoglycaemic clamp study at 2.5 mmol/l with measurement of hormonal counterregulatory response, symptom scores and cognitive testing (four-choice reaction time and digit symbol substitution test). Each intervention and subsequent clamp study was separated by at least 2 weeks. The participants and investigators were not blinded to the intervention or measurements during the study. The investigators were blinded to the primary outcome and blood analysis results. RESULTS All participants (six male and six female, age 19-54 years, median [IQR] duration of type 1 diabetes 24.5 [17.3-29.0] years, mean [SEM] HbA1c 56 [3.67] mmol/mol; 7.3% [0.34%]) completed the study (both interventions and two clamps). In comparison with the rest study, a single episode of HIT led to a 29% increase in the adrenaline (epinephrine) response (mean [SEM]) (2286.5 [343.1] vs 2953.8 [384.9] pmol/l); a significant increase in total symptom scores (Edinburgh Hypoglycaemia Symptom Scale: 24.25 [2.960 vs 27.5 [3.9]; p<0.05), and a significant prolongation of four-choice reaction time (591.8 [22.5] vs 659.9 [39.86] ms; p<0.01] during equivalent hypoglycaemia induced the following day. CONCLUSIONS/INTERPRETATION These findings are consistent with the hypothesis that IAH develops in people with type 1 diabetes as a habituated response and that introduction of a novel stressor can restore, at least partially, the adapted counterregulatory hormonal, symptomatic and cognitive responses to hypoglycaemia. TRIAL REGISTRATION ISRCTN15236211.
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Affiliation(s)
- Catriona M Farrell
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, DD19SY, UK
| | - Alison D McNeilly
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, DD19SY, UK
| | - Paul Fournier
- Faculty of Science, School of Human Science, The University of Western Australia, Perth, Australia
| | - Timothy Jones
- Faculty of Health and Medical Sciences, Paediatrics, The University of Western Australia, Perth, Australia
| | - Simona M Hapca
- Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Daniel West
- Institute of Cellular Medicine, Faculty of Medical Science, Newcastle University, Newcastle, UK
| | - Rory J McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, DD19SY, UK.
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Rodriguez-Gutierrez R, Salcido-Montenegro A, Singh-Ospina NM, Maraka S, Iñiguez-Ariza N, Spencer-Bonilla G, Tamhane SU, Lipska KJ, Montori VM, McCoy RG. Documentation of hypoglycemia assessment among adults with diabetes during clinical encounters in primary care and endocrinology practices. Endocrine 2020; 67:552-560. [PMID: 31802353 PMCID: PMC7192242 DOI: 10.1007/s12020-019-02147-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE To examine the proportion of diabetes-focused clinical encounters in primary care and endocrinology practices where the evaluation for hypoglycemia is documented; and when it is, identify clinicians' stated actions in response to patient-reported events. METHODS A total of 470 diabetes-focused encounters among 283 patients nonpregnant adults (≥18 years) with type 1 or type 2 diabetes mellitus in this retrospective cohort study. Participants were randomly identified in blocks of treatment strategy and care location (95 and 52 primary care encounters among hypoglycemia-prone medications (i.e. insulin, sulfonylurea) and others patients, respectively; 94 and 42 endocrinology encounters among hypo-treated and others, respectively). Documentation of hypoglycemia and subsequent management plan in the electronic health record were evaluated. RESULTS Overall, 132 (46.6%) patients had documentation of hypoglycemia assessment, significantly more prevalent among hypo-treated patients seen in endocrinology than in primary care (72.3% vs. 47.4%; P = 0.001). Hypoglycemia was identified by patient in 38.2% of encounters. Odds of hypoglycemia assessment documentation was highest among the hypo-treated (OR 13.6; 95% CI 5.5-33.74, vs. others) and patients seen in endocrine clinic (OR 4.48; 95% CI 2.3-8.6, vs. primary care). After documentation of hypoglycemia, treatment was modified in 30% primary care and 46% endocrine clinic encounters; P = 0.31. Few patients were referred to diabetes self-management education and support (DSMES). CONCLUSIONS Continued efforts to improve hypoglycemia evaluation, documentation, and management are needed, particularly in primary care. This includes not only screening at-risk patients for hypoglycemia, but also modifying their treatment regimens and/or leveraging DSMES.
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Affiliation(s)
- Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. JoséE. González", Universidad Autonoma de Nuevo Leon, 64460, Monterrey, México
- Plataforma INVEST Medicina UANL-KER Unit (KER Unit México), Subdirección de Investigación, Universidad Autónoma de Nuevo León, 64460, Monterrey, México
| | - Alejandro Salcido-Montenegro
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. JoséE. González", Universidad Autonoma de Nuevo Leon, 64460, Monterrey, México
- Plataforma INVEST Medicina UANL-KER Unit (KER Unit México), Subdirección de Investigación, Universidad Autónoma de Nuevo León, 64460, Monterrey, México
| | - Naykky M Singh-Ospina
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, 32606, USA
| | - Spyridoula Maraka
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Health Care System, Little Rock, AR, USA
| | - Nicole Iñiguez-Ariza
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gabriela Spencer-Bonilla
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Shrikant U Tamhane
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kasia J Lipska
- Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Rozalina G McCoy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Hendrieckx C, Gonder-Frederick L, Heller SR, Snoek FJ, Speight J. How has psycho-behavioural research advanced our understanding of hypoglycaemia in type 1 diabetes? Diabet Med 2020; 37:409-417. [PMID: 31814151 DOI: 10.1111/dme.14205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 11/29/2022]
Abstract
Almost 100 years since the discovery of insulin, hypoglycaemia remains a barrier for people with type 1 diabetes to achieve and maintain blood glucose at levels which prevent long-term diabetes-related complications. Although hypoglycaemia is primarily attributable to the limitations of current treatment and defective hormonal counter-regulation in type 1 diabetes, the central role of psycho-behavioural factors in preventing, recognizing and treating hypoglycaemia has been acknowledged since the early 1980s. Over the past 25 years, as documented in the present review, there has been a substantial increase in psycho-behavioural research focused on understanding the experience and impact of hypoglycaemia. The significant contributions have been in understanding the impact of hypoglycaemia on a person's emotional well-being and aspects of life (e.g. sleep, driving, work/social life), identifying modifiable psychological and behavioural risk factors, as well as in developing psycho-behavioural interventions to prevent and better manage (severe) hypoglycaemia. The impact of hypoglycaemia on family members has also been confirmed. Structured diabetes education programmes and psycho-behavioural interventions with a focus on hypoglycaemia have both been shown to be effective in addressing problematic hypoglycaemia. However, the findings have also revealed the complexity of the problem and the need for a personalized approach, taking into account the individual's knowledge of, and emotional/behavioural reactions to hypoglycaemia. Evidence is emerging that people with persistent and recurrent severe hypoglycaemia, characterized by deeply entrenched cognitions and lack of concern around hypoglycaemia, can benefit from tailored cognitive behavioural therapy.
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Affiliation(s)
- C Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - L Gonder-Frederick
- Centre for Diabetes Technology, Department of Psychiatry and Neurobehavioural Sciences, University of Virginia, Charlottesville, VA, USA
| | - S R Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - F J Snoek
- Department of Medical Psychology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, The Netherlands
| | - J Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
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Parikh L, Seo D, Lacadie C, Belfort-Deaguiar R, Groskreutz D, Hamza M, Dai F, Scheinost D, Sinha R, Todd Constable R, Sherwin R, Hwang JJ. Differential Resting State Connectivity Responses to Glycemic State in Type 1 Diabetes. J Clin Endocrinol Metab 2020; 105:5568225. [PMID: 31511876 PMCID: PMC6936965 DOI: 10.1210/clinem/dgz004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/28/2019] [Accepted: 08/30/2019] [Indexed: 12/13/2022]
Abstract
CONTEXT Individuals with type 1 diabetes mellitus (T1DM) have alterations in brain activity that have been postulated to contribute to the adverse neurocognitive consequences of T1DM; however, the impact of T1DM and hypoglycemic unawareness on the brain's resting state activity remains unclear. OBJECTIVE To determine whether individuals with T1DM and hypoglycemia unawareness (T1DM-Unaware) had changes in the brain resting state functional connectivity compared to healthy controls (HC) and those with T1DM and hypoglycemia awareness (T1DM-Aware). DESIGN Observational study. SETTING Academic medical center. PARTICIPANTS 27 individuals with T1DM and 12 HC volunteers participated in the study. INTERVENTION All participants underwent blood oxygenation level dependent (BOLD) resting state functional magnetic brain imaging during a 2-step hyperinsulinemic euglycemic (90 mg/dL)-hypoglycemic (60 mg/dL) clamp. OUTCOME Changes in resting state functional connectivity. RESULTS Using 2 separate methods of functional connectivity analysis, we identified distinct differences in the resting state brain responses to mild hypoglycemia between HC, T1DM-Aware, and T1DM-Unaware participants, particularly in the angular gyrus, an integral component of the default mode network (DMN). Furthermore, changes in angular gyrus connectivity also correlated with greater symptoms of hypoglycemia (r = 0.461, P = 0.003) as well as higher scores of perceived stress (r = 0.531, P = 0.016). CONCLUSION These findings provide evidence that individuals with T1DM have changes in the brain's resting state connectivity patterns, which may be further associated with differences in awareness to hypoglycemia. These changes in connectivity may be associated with alterations in functional outcomes among individuals with T1DM.
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Affiliation(s)
- Lisa Parikh
- Section of Endocrinology, Yale School of Medicine, New Haven, CT, US
| | - Dongju Seo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Cheryl Lacadie
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, US
| | | | - Derek Groskreutz
- Section of Endocrinology, Yale School of Medicine, New Haven, CT, US
| | - Muhammad Hamza
- Section of Endocrinology, Yale School of Medicine, New Haven, CT, US
| | - Feng Dai
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, US
| | - Dustin Scheinost
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, US
| | - Rajita Sinha
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - R Todd Constable
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, US
| | - Robert Sherwin
- Section of Endocrinology, Yale School of Medicine, New Haven, CT, US
| | - Janice Jin Hwang
- Section of Endocrinology, Yale School of Medicine, New Haven, CT, US
- Correspondence and Reprint Requests: Janice Hwang, The Anylan Center, TAC 119S, New Haven, CT 06520, USA. E-mail:
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47
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Flatt AJS, Little SA, Speight J, Leelarathna L, Walkinshaw E, Tan HK, Bowes A, Lubina-Solomon A, Holmes-Truscott E, Chadwick TJ, Wood R, McDonald TJ, Kerr D, Flanagan D, Brooks A, Heller SR, Evans ML, Shaw JAM. Predictors of Recurrent Severe Hypoglycemia in Adults With Type 1 Diabetes and Impaired Awareness of Hypoglycemia During the HypoCOMPaSS Study. Diabetes Care 2020; 43:44-52. [PMID: 31484666 DOI: 10.2337/dc19-0630] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/06/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The HypoCOMPaSS study was designed to test the hypothesis that successful avoidance of biochemical hypoglycemia without compromising overall glycemic control would restore sufficient hypoglycemia awareness to prevent recurrent severe hypoglycemia in the majority of participants with established type 1 diabetes. Before starting the study, we planned to investigate associations between baseline characteristics and recurrent severe hypoglycemia over 2 years' follow-up. RESEARCH DESIGN AND METHODS A total of 96 adults with type 1 diabetes and impaired awareness of hypoglycemia participated in a 24-week 2 × 2 factorial randomized controlled trial comparing insulin delivery and glucose monitoring modalities, with the goal of rigorous biochemical hypoglycemia avoidance. The analysis included 71 participants who had experienced severe hypoglycemia in the 12-month prestudy with confirmed absence (complete responder) or presence (incomplete responder) of severe hypoglycemia over 24 months' follow-up. RESULTS There were 43 (61%) complete responders and 28 (39%) incomplete responders experiencing mean ± SD 1.5 ± 1.0 severe hypoglycemia events/person-year. At 24 months, incomplete responders spent no more time with glucose ≤3 mmol/L (1.4 ± 2.1% vs. 3.0 ± 4.8% for complete responders; P = 0.26), with lower total daily insulin dose (0.45 vs. 0.58 units/24 h; P = 0.01) and greater impairment of hypoglycemia awareness (Clarke score: 3.8 ± 2.2 vs. 2.0 ± 1.9; P = 0.01). Baseline severe hypoglycemia rate (16.9 ± 16.3 vs. 6.4 ± 10.8 events/person-year; P = 0.002) and fear of hypoglycemia were higher in incomplete responders. Peripheral neuropathy was more prevalent in incomplete responders (11 [39%] vs. 2 [4.7%]; P < 0.001) with a trend toward increased autonomic neuropathy. CONCLUSIONS Recurrent severe hypoglycemia was associated with higher preintervention severe hypoglycemia rate, fear of hypoglycemia, and concomitant neuropathy.
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Affiliation(s)
- Anneliese J S Flatt
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K.,Newcastle Diabetes Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
| | - Stuart A Little
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K.,Newcastle Diabetes Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.,AHP Research, Hornchurch, U.K
| | - Lalantha Leelarathna
- Wellcome Trust-MRC Institute of Metabolic Science Metabolic Research Laboratories, University of Cambridge, Cambridge, U.K
| | - Emma Walkinshaw
- School of Medicine and Biomedical Sciences, The University of Sheffield, Sheffield, U.K
| | - Horng Kai Tan
- Peninsula College of Medicine and Dentistry, Plymouth, U.K
| | - Anita Bowes
- Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, U.K
| | | | - Elizabeth Holmes-Truscott
- Newcastle Diabetes Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Thomas J Chadwick
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, U.K
| | - Ruth Wood
- Newcastle Clinical Trials Unit, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, U.K
| | - Timothy J McDonald
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, U.K
| | - David Kerr
- Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, U.K.,Sansum Diabetes Research Institute, Santa Barbara, CA
| | | | - Augustin Brooks
- Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, U.K
| | - Simon R Heller
- School of Medicine and Biomedical Sciences, The University of Sheffield, Sheffield, U.K
| | - Mark L Evans
- Wellcome Trust-MRC Institute of Metabolic Science Metabolic Research Laboratories, University of Cambridge, Cambridge, U.K
| | - James A M Shaw
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K. .,Newcastle Diabetes Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
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Bisio A, Gamarra E, Broglio F, Grassi G. Coping strategies in people with type 1 diabetes on insulin pump treatment. MINERVA ENDOCRINOL 2020; 44:336-343. [DOI: 10.23736/s0391-1977.19.03024-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Soukup T, Hull L, Smith EL, Healey A, Bakolis I, Amiel SA, Sevdalis N. Effectiveness-implementation hybrid type 2 trial evaluating two psychoeducational programmes for severe hypoglycaemia in type 1 diabetes: implementation study protocol. BMJ Open 2019; 9:e030370. [PMID: 31727650 PMCID: PMC6886982 DOI: 10.1136/bmjopen-2019-030370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/13/2019] [Accepted: 09/02/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Two of the most acute and feared complications in type 1 diabetes (T1D) are hypoglycaemia and severe hypoglycaemia (SH). While impaired awareness of hypoglycaemia (IAH) can lead to SH with cognitive and motivational barriers implicated, the available education does not integrate behavioural change techniques to address these. A novel Hypoglycaemia Awareness Restoration Programme despite optimised care (HARPdoc) is currently being tested against an established blood glucose awareness training (BGAT) within a parallel, two-arm, group randomised, blinded trial (with its own protocol; NCT02940873) with adults with T1D whose problems with hypoglycaemia and SH have persisted despite otherwise optimised insulin management. While both programmes are aimed at reducing hypoglycaemia, SH and IAH, it is the former that integrates behavioural change techniques.The aim of the current (implementation) study is to evaluate delivery of both HARPdoc and BGAT and explore associations between implementation outcomes and trial endpoints; as well as to develop an evidence-based implementation blueprint to guide implementation, sustainment and scale-up of the effective programmes. METHODS AND ANALYSIS Guided by the implementation science tools, frameworks, methods and principles, the current study was designed through a series of focus groups (n=11) with the key intervention stakeholders (n=28)-including (1) individuals with lived experience of T1D, IAH and a pilot version of the HARPdoc (n=6) and (2) diabetes healthcare professionals (n=22). A mixed-methods approach will be used throughout. Stakeholder engagement has underpinned study design and materials to maximise relevance, feasibility and impact. ETHICS AND DISSEMINATION The protocol has been reviewed and received ethical approval by the Harrow Research Ethics Committee (18/LO/1020; 240752) on 1 October 2018. The findings will be submitted to a peer-reviewed journal and presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT02940873; Pre-results.
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Affiliation(s)
- Tayana Soukup
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Louise Hull
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Lauretta Smith
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
- Department of Diabetes, King's College Hospital, London, UK
| | - Andy Healey
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
| | - Stephanie A Amiel
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
- Department of Diabetes, King's College Hospital, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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50
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Cook AJ, DuBose SN, Foster N, Smith EL, Wu M, Margiotta G, Rickels MR, Speight J, de Zoysa N, Amiel SA. Cognitions Associated With Hypoglycemia Awareness Status and Severe Hypoglycemia Experience in Adults With Type 1 Diabetes. Diabetes Care 2019; 42:1854-1864. [PMID: 31391200 DOI: 10.2337/dc19-0002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 07/13/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Impaired awareness of hypoglycemia (IAH) and recurrent severe hypoglycemia (RSH) remain problematic for people with type 1 diabetes (T1D), despite major therapeutic advances. We explored beliefs around hypo- and hyperglycemia in adults with T1D with, and without, IAH and RSH. RESEARCH DESIGN AND METHODS A cross-sectional U.S. multicenter survey included Attitudes to Awareness of Hypoglycemia (A2A; a 19-item questionnaire concerning beliefs about hypoglycemia), the Gold score (single item: awareness of hypoglycemia), and a question about severe hypoglycemia over the preceding year. The survey was emailed to 6,200 adult participants of the annual T1D Exchange clinic registry data collection. A2A data were subjected to principal component analysis with varimax rotation. RESULTS Among 1,978 respondents (response rate 32%), 61.7% were women, mean ± SD age was 39.6 ± 16.3 years, and T1D duration was 23.1 ± 13.8 years. Thirty-seven percent reported IAH, 16% RSH, and 9% both. A2A items segregated into three factors, differently distributed by hypoglycemia experience. Respondents with IAH or RSH expressed appropriate concern about hypoglycemia, but those with IAH were more likely to prioritize hyperglycemia concerns than those with intact awareness (P = 0.002). Those with RSH showed greater normalization of asymptomatic hypoglycemia than those without (P = 0.019) and trended toward prioritizing hyperglycemia concerns (P = 0.097), driven by those with both IAH and RSH. CONCLUSIONS Adults with T1D with IAH and RSH report specific cognitions about hypoglycemia and hyperglycemia, which may act as barriers to hypoglycemia avoidance and recovery of awareness. These may be modifiable and present a target for enhancing engagement of vulnerable people with strategies to avoid future hypoglycemia.
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Affiliation(s)
- Amelia J Cook
- Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, U.K
| | | | | | - Emma L Smith
- Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, U.K
| | - Mengdi Wu
- Jaeb Center for Health Research, Tampa, FL
| | - Georgina Margiotta
- Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, U.K
| | - Michael R Rickels
- Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.,AHP Research, Essex, U.K
| | - Nicole de Zoysa
- Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, U.K
| | - Stephanie A Amiel
- Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, U.K. .,Institute of Diabetes, Obesity and Endocrinology, King's Health Partners, London, U.K
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