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Zammitt NN, Forbes S, Inkster B, Strachan MWJ, Wright RJ, Dover AR, Stimson RH, Gibb FW. Predictors of impaired awareness of hypoglycaemia and severe hypoglycaemia in adults with type 1 diabetes. Diabet Med 2025:e70074. [PMID: 40386839 DOI: 10.1111/dme.70074] [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: 03/16/2025] [Revised: 05/05/2025] [Accepted: 05/08/2025] [Indexed: 05/20/2025]
Abstract
AIMS This study aimed to assess the prevalence of impaired awareness of hypoglycaemia (IAH) and severe hypoglycaemia (SH) in adults with type 1 diabetes and identify risk factors for both conditions in a contemporary cohort. METHODS A cross-sectional survey was conducted on 782 adults with type 1 diabetes. Participants completed a questionnaire including validated hypoglycaemia awareness and mental health tools. Continuous glucose monitoring (CGM) data were collected in 402 participants. SH was identified based on self-reported episodes. RESULTS 89% were CGM users and 27% were using continuous subcutaneous insulin infusion (CSII). 5.3% of participants reported a recent episode of SH and 21% had IAH based on the Gold score. Elevated Gold Score was independently associated with socioeconomic deprivation (OR 1.9, p = 0.002), female sex (OR 1.8, p = 0.002) and positive depression screen (OR 2.1, p = 0.007). Hypoglycaemia detection threshold <3.0 mM was independently associated with older age (OR 1.03 per year, p < 0.001) and positive depression screen (OR 2.7, p < 0.001). Greater glucose variability (OR 1.14 per % CV glucose, p < 0.001), positive anxiety screen (OR 3.0, p = 0.031) and detection threshold <3.0 mM (OR 6.7, p < 0.001) were all independently associated with SH risk. CONCLUSIONS The prevalence of SH is lower in the modern era of type 1 diabetes management and may reflect greater use of CGM and CSII. Mental health symptoms and socioeconomic deprivation are key associations with IAH and SH. Risk models incorporating clinical, psychological and CGM data may more effectively predict SH.
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Affiliation(s)
- Nicola N Zammitt
- Edinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK
| | - Shareen Forbes
- Edinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Berit Inkster
- Edinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK
| | - Mark W J Strachan
- Edinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK
| | - Rohana J Wright
- Edinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK
| | - Anna R Dover
- Edinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK
| | - Roland H Stimson
- Edinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Özdemir EK, İçen S, Döğer E, Torun YT, Solmaz N, Çamurdan MO, Bideci A. The relationship between food addiction, eating attitudes, and psychiatric symptoms with metabolic control in adolescents with Type 1 Diabetes Mellitus. J Eat Disord 2025; 13:58. [PMID: 40176195 PMCID: PMC11966810 DOI: 10.1186/s40337-025-01242-w] [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: 12/10/2024] [Accepted: 03/14/2025] [Indexed: 04/04/2025] Open
Abstract
BACKGROUND Metabolic control is of critical importance in children with Type 1 Diabetes Mellitus (T1DM) for the stabilization of blood glucose levels and long-term health outcomes. Dietary choices play an important role in glucose control and the prevention of diabetes-related complications. This study aims to investigate the relationship between food addiction, eating attitudes, and psychiatric symptoms with metabolic control in adolescents diagnosed with T1DM. METHODS Participants (N = 100) were assessed using the Yale Food Addiction Scale (Y-FAS), Eating Attitudes Test-40 (EAT-40), and Brief Symptom Inventory (BSI) to evaluate food addiction, eating attitudes, and psychiatric symptoms. Metabolic parameters of adolescents with T1DM, such as body mass index (BMI), HbA1c levels, insulin dosage, duration of diabetes, and the incidence of ketoacidosis and hypoglycemia, were recorded. RESULTS The study found that 15% of adolescents had food addiction criteria, and 17% were prone to disordered eating behaviors. The presence of a history of hypoglycemia was related to a higher total symptom score on YFAS and higher total scores, depression, anxiety, somatization, and hostility subscale scores on BSI (p <.05 for all). BMI was positively correlated with anxiety about gaining weight on EAT-40 and higher total scores, depression, and anxiety subscale scores on BSI (p <.05 for all). As the BMI percentile group increased from normal to overweight/obesity, more food addiction symptoms were observed, and significant increases were found in depression, anxiety, negative self-perception, and somatization subscale scores, and the BSI total score (p <.05 for all). CONCLUSIONS Findings suggest that adolescents with T1DM may have a higher susceptibility to food addiction and eating disorders compared to the rates reported in the general population. Hypoglycemia can be a metabolic risk factor for food addiction in adolescents with T1DM. Psychological problems such as depression, anxiety, and somatization in adolescents with T1DM are associated with poor metabolic control. Further studies are needed with larger and more diverse samples.
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Affiliation(s)
- Esma Kaya Özdemir
- Department of Child Health and Diseases, Department of Pediatric Endocrinology, Gazi University Faculty of Medicine, Ankara, Türkiye.
- Gazi University Faculty of Medicine, Ankara, Çankaya, Türkiye.
| | - Sarper İçen
- Department of Child and Adolescent Mental Health and Diseases, Gazi University Faculty of Medicine, Ankara, Türkiye
- Department of Child and Adolescent Mental Health and Diseases, Ahi Evran University Research and Training Hospital, Kırşehir, Türkiye
| | - Esra Döğer
- Department of Child Health and Diseases, Department of Pediatric Endocrinology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Yasemin Taş Torun
- Department of Child and Adolescent Mental Health and Diseases, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Nihan Solmaz
- Department of Child Health and Diseases, Department of Pediatric Endocrinology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - M Orhun Çamurdan
- Department of Child Health and Diseases, Department of Pediatric Endocrinology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Aysun Bideci
- Department of Child Health and Diseases, Department of Pediatric Endocrinology, Gazi University Faculty of Medicine, Ankara, Türkiye
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Sepúlveda E, Poínhos R, Nata G, Gaspar N, Freitas P, Vicente SG, Amiel SA, Carvalho D. Relationship between severe hypoglycemia or impaired awareness of hypoglycemia and diabetes-related health status, global cognition and executive functions in adults with type 1 diabetes without severe anxiety or depression. Diabetes Res Clin Pract 2025; 221:112004. [PMID: 39805380 DOI: 10.1016/j.diabres.2025.112004] [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: 10/26/2024] [Revised: 01/07/2025] [Accepted: 01/08/2025] [Indexed: 01/16/2025]
Abstract
AIMS To explore the relationship between impaired awareness of hypoglycemia (IAH) or severe hypoglycemia (SH), and health status and cognition in adults with type 1 diabetes (T1D). METHODS T1D adults attending a tertiary diabetes service were recruited into this cross-sectional study. People screening positive for severe anxiety or depression were not included. Hypoglycemia awareness status was assessed using the full-scale and factor 1 of the Minimally Modified Clarke Hypoglycemia Survey (MMCHS; ≥4 and ≥2 = IAH); and data collected on health status (Diabetes Health Profile: barriers to activity, BA; psychological distress, PD; disinhibited eating); global cognition (Montreal Cognitive Assessment); and executive functions (EF; INECO Frontal Screening, IFS). A score of reduced awareness in item 3 and/or 4 of the MMCHS defined experience of ≥1 SH in past 6-12 months. RESULTS In 165 T1D adults, prevalences of SH, IAH by MMCHS full-scale and factor 1 were 35%, 13% and 28%. Participants with IAH by factor 1 had higher scores for PD (p = 0.008). Participants with SH and IAH (full-scale or factor 1) had higher BA scores (all p < 0.05) but no impairment of global cognition or EF. Participant Z-score IFS was lower than in non-diabetic individuals (p < 0.001). CONCLUSIONS In our cohort, executive dysfunction in T1D was not associated with SH or IAH. IAH was associated with PD, and both SH and IAH were related to behavioral dysfunction.
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Affiliation(s)
- Eduardo Sepúlveda
- Center for Psychology at the Universidade do Porto, Faculty of Psychology and Educational Sciences, Universidade do Porto, Porto, Portugal; Diabetes Research Group, King's College London, London, UK; Clínica Privada de Guimarães, Guimarães, Portugal.
| | - Rui Poínhos
- Faculty of Nutrition and Food Sciences, Universidade do Porto, Porto, Portugal
| | - Gil Nata
- Center for Research and Intervention in Education and Center for Psychology at the Universidade do Porto, Faculty of Psychology and Educational Sciences, Universidade do Porto, Porto, Portugal
| | - Nuno Gaspar
- Center for Psychology at the Universidade do Porto, Faculty of Psychology and Educational Sciences, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; ULS São João, Porto, Portugal
| | - Selene G Vicente
- Center for Psychology at the Universidade do Porto, Faculty of Psychology and Educational Sciences, Universidade do Porto, Porto, Portugal
| | - Stephanie A Amiel
- Diabetes Research Group, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Davide Carvalho
- Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Lin YK, Ye W, Hepworth E, Agni A, Matus AM, Flatt AJ, Shaw JAM, Rickels MR, Amiel SA, Speight J. Characterising impaired awareness of hypoglycaemia and associated risks through HypoA-Q: findings from a T1D Exchange cohort. Diabetologia 2025; 68:433-443. [PMID: 39477881 PMCID: PMC11837905 DOI: 10.1007/s00125-024-06310-5] [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] [Received: 06/15/2024] [Accepted: 09/17/2024] [Indexed: 01/15/2025]
Abstract
AIMS/HYPOTHESIS We aimed to: (1) externally validate the five-item Hypoglycaemia Awareness Questionnaire (HypoA-Q) impaired awareness subscale (HypoA-Q IA); (2) examine how impaired awareness of hypoglycaemia (IAH) relates to the risk of severe hypoglycaemia and level 2 hypoglycaemia; and (3) identify factors associated with IAH. METHODS Nationwide survey of T1D Exchange registrants was conducted to collect data on demographics, 6 month severe-hypoglycaemia history, hypoglycaemia awareness status (via HypoA-Q IA, the Gold instrument and the Clarke instrument) and continuous glucose monitor (CGM) measures. The Clarke hypoglycaemia awareness factor (Clarke-HAF) was calculated to exclude severe-hypoglycaemia history items. Analyses included Cronbach's α, Spearman correlations and logistic regression. RESULTS Valid survey responses were collected from N=1580 adults with type 1 diabetes (median age, 44 years; 52% female participants; median HbA1c, 48 mmol/mol [6.5%]). Of these, 94% of participants were using CGMs and 69% were using hybrid closed-loop (HCL) systems; 30% had at least one severe-hypoglycaemia episode in the past 6 months. The HypoA-Q IA had satisfactory internal reliability (α=0.79) and construct validity. Higher HypoA-Q IA scores were independently associated with greater risk of severe hypoglycaemia (p<0.001), performing comparably to the Gold instrument and the Clarke-HAF instrument. HypoA-Q IA-determined IAH was independently associated with 88% higher odds of developing severe hypoglycaemia (p<0.001) and twofold higher odds for spending ≥1% of time in level 2 hypoglycaemia (p=0.011). Higher age and longer diabetes duration were associated with higher IAH risk (p<0.001). CGM and HCL use was associated with lower IAH risk (p<0.001). CONCLUSIONS/INTERPRETATION The HypoA-Q IA is a brief, valid and reliable tool for assessing IAH in today's technology-oriented era. IAH was independently associated with severe hypoglycaemia and level 2 hypoglycaemia in a cohort with high prevalence of advanced diabetes technology use and HbA1c within the recommended range. CGM and HCL use was related to lower IAH risk.
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Affiliation(s)
- Yu Kuei Lin
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Emily Hepworth
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Annika Agni
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Austin M Matus
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Anneliese J Flatt
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - James A M Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michael R Rickels
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Jane Speight
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Mirghani HO. Diabetes distress, the mediator of the poor glycemic control and depression: A meta-analysis. World J Meta-Anal 2024; 12:97779. [DOI: 10.13105/wjma.v12.i4.97779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 11/01/2024] [Accepted: 12/05/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND Diabetes-related distress (DRD) is a common psychological disorder specifically associated with diabetes, its cross-talk with depression, and glycated hemoglobin (HbA1c) was discussed controversially. Interventions addressing DRD were shown to improve HbA1c. However, the primary concern is to investigate the association of DRD with glycemic control. No meta-analyses have compared the effects of depression and diabetes distress on HbA1c.
AIM To assess the relationship between DRD, depression, and glycemic control.
METHODS We systematically searched PubMed MEDLINE, Google Scholar, and Cochrane Library from inception up to May 2024. The keywords diabetes distress, depression, psychopathology, glycemic control, HbA1c, glycated hemoglobin, fasting, and postprandial blood glucose were used. A datasheet was used to extract the author’s name year and country of publication, diabetes distress, depression, and HbA1c among patients with DRD, depression, and control subjects.
RESULTS Out of the 2046 studies retrieved, 55 full texts were screened and 22 studies were included in the final meta-analysis. Diabetes distress was associated with poor glycemic control, odd ratio = 0.42, 95% confidence interval (CI): 0.17-0.67, and P value < 0.001, and odd ratio = 0.52, 95%CI: 0.38-0.72, and P value < 0.001 respectively. No significant difference was observed between depression and DRD regarding the impact on HbA1c, odd ratio = 0.13, 95%CI: 0.15-0.41, P value = 0.37, I2 for heterogeneity = 76%. However, when heterogeneity was eliminated, diabetes distress influenced the HbA1c more compared to depression, odd ratio = 0.29, 95%CI: 0.17-0.41, and P value < 0.001.
CONCLUSION DRD negatively influenced the HbA1c and glycemic control more than depression. Further studies using more specific measures (ecological momentary assessment) to assess DRD are recommended.
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Affiliation(s)
- Hyder O Mirghani
- Department of Internal Medicine, University of Tabuk, Tabuk 51941, Tabuk Province, Saudi Arabia
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Efthymiadis A, Bastounis A, Liu L, Bourlaki M, Spinos D, Tsikopoulos K. The impact of closed-loop automated insulin delivery systems on hypoglycaemia awareness in people living with type 1 diabetes: A systematic review and meta-analysis. J Diabetes Metab Disord 2024; 23:2251-2261. [PMID: 39610490 PMCID: PMC11599659 DOI: 10.1007/s40200-024-01492-6] [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: 06/26/2024] [Accepted: 08/17/2024] [Indexed: 11/30/2024]
Abstract
OBJECTIVES Impaired awareness of hyperglycaemia (IAH) affects approximately 20-40% of people living with type 1 diabetes (T1D), predisposing them to severe hypoglycaemia. This systematic review evaluated the efficacy of closed-loop automated insulin delivery systems (CL-AID) in restoring IAH compared with standard diabetes care, including other diabetes technologies. METHODS Six electronic databases were searched for published and unpublished observational and randomised-control studies (RCTs) from inception to 29th of May 2024. The results of observational studies and RCTs were meta-analysed separately to calculate the effect of CL-AID on IAH in people living with T1D. Quality assessment of studies was performed using the Joanna-Briggs appraisal tool for cohort studies and the Risk of Bias (Rob-2) tool for RCTs. RESULTS Meta-analysis of four prospective observations studies (n = 583) demonstrated a statistically significant improvement in hypoglycaemia awareness upon transition to a hybrid closed-loop (HCL) system compared with standard diabetes care in people with T1D, Clarke score mean difference (MD) of -0.45 (-0.69 to -0.22, p = 0.0001). However, this was less than 1 point, which is the minimum clinically important difference (MCID) of Clarke score. Meta-analysis of three RCTs (n = 55) comparing standard diabetes care did not demonstrate any statistically significant effect on hypoglycaemia awareness, Clarke score MD of -0.69 (-1.89 to 0.50, p = 0.26). CONCLUSIONS This systematic review demonstrated that transition from standard diabetes care to HCL has the potential to improve hypoglycaemia awareness in people with T1D and IAH, but this might not be of major clinical significance. Hence, psychoeducational interventions continue to be the cornerstone of IAH management. Novel therapeutic modalities, such as bi-hormonal automated delivery systems, need to be further explored to help restore hypoglycaemia awareness. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40200-024-01492-6.
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Affiliation(s)
- Agathoklis Efthymiadis
- Department of Diabetes & Endocrinology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, London, Harrow HA1 3UJ UK
| | - Anastasios Bastounis
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Linda Liu
- LNWH Library Service, London North West University Healthcare NHS Trust, Watford Road, London, Harrow HA1 3UJ UK
| | - Marianthi Bourlaki
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2WB UK
| | - Dimitrios Spinos
- Department of Otorhinolaryngology, Head and Neck Surgery, South Warwickshire University Hospitals NHS Trust, Lakin Rd, Warwick, CV345B UK
| | - Konstantinos Tsikopoulos
- Orthopaedic Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, 54124OX3 7LD Oxford, UK
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Monroy-Iglesias MJ, Russell B, Martin S, Fox L, Moss C, Bruno F, Millwaters J, Steward L, Murtagh C, Cargaleiro C, Bater D, Lavelle G, Simpson A, Onih J, Haire A, Reeder C, Jones G, Smith S, Santaolalla A, Van Hemelrijck M, Dolly S. Anxiety and depression in patients with non-site-specific cancer symptoms: data from a rapid diagnostic clinic. Front Oncol 2024; 14:1358888. [PMID: 38887232 PMCID: PMC11180766 DOI: 10.3389/fonc.2024.1358888] [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: 02/08/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024] Open
Abstract
Background Rapid diagnostic clinics (RDCs) provide a streamlined holistic pathway for patients presenting with non-site specific (NSS) symptoms concerning of malignancy. The current study aimed to: 1) assess the prevalence of anxiety and depression, and 2) identify a combination of patient characteristics and symptoms associated with severe anxiety and depression at Guy's and St Thomas' Foundation Trust (GSTT) RDC in Southeast London. Additionally, we compared standard statistical methods with machine learning algorithms for predicting severe anxiety and depression. Methods Patients seen at GSTT RDC between June 2019 and January 2023 completed the General Anxiety Disorder Questionnaire (GAD-7) and Patient Health Questionnaire (PHQ-8) questionnaires, at baseline. We used logistic regression (LR) and 2 machine learning (ML) algorithms (random forest (RF), support vector machine (SVM)) to predict risk of severe anxiety and severe depression. The models were constructed using a set of sociodemographic and clinical variables. Results A total of 1734 patients completed GAD-7 and PHQ-8 questionnaires. Of these, the mean age was 59 years (Standard Deviation: 15.5), and 61.5% (n:1067) were female. Prevalence of severe anxiety (GAD-7 score ≥15) was 13.8% and severe depression (PHQ-8 score≥20) was 9.3%. LR showed that a combination of previous mental health condition (PMH, Adjusted Odds Rario (AOR) 3.28; 95% confidence interval (CI) 2.36-4.56), symptom duration >6 months (AOR 2.20; 95%CI 1.28-3.77), weight loss (AOR 1.88; 95% CI 1.36-2.61), progressive pain (AOR 1.71; 95%CI 1.26-2.32), and fatigue (AOR 1.36; 95%CI 1.01-1.84), was positively associated with severe anxiety. Likewise, a combination PMH condition (AOR 3.95; 95%CI 2.17-5.75), fatigue (AOR 2.11; 95%CI 1.47-3.01), symptom duration >6 months (AOR 1.98; 95%CI 1.06-3.68), weight loss (AOR 1.66; 95%CI 1.13-2.44), and progressive pain (AOR 1.50; 95%CI 1.04-2.16), was positively associated with severe depression. LR and SVM had highest accuracy levels for severe anxiety (LR: 86%, SVM: 85%) and severe depression (SVM: 89%, LR: 86%). Conclusion High prevalence of severe anxiety and severe depression was found. PMH, fatigue, weight loss, progressive pain, and symptoms >6 months emerged as combined risk factors for both these psychological comorbidities. RDCs offer an opportunity to alleviate distress in patients with concerning symptoms by expediting diagnostic evaluations.
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Affiliation(s)
- Maria J. Monroy-Iglesias
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Beth Russell
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Sabine Martin
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Louis Fox
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Charlotte Moss
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Flaminia Bruno
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Juliet Millwaters
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Lindsay Steward
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Colette Murtagh
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Carlos Cargaleiro
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Darren Bater
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Grace Lavelle
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom
| | - Anna Simpson
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom
| | - Jemima Onih
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom
| | - Anna Haire
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Clare Reeder
- Macmillan Psychological Support (MAPS) Team, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Geraint Jones
- South East London Cancer Alliance, London, United Kingdom
| | - Sue Smith
- Dimbleby Cancer Care, Guy’s Cancer Centre, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Aida Santaolalla
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
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Healey A, Soukup T, Sevdalis N, Bakolis I, Cross S, Heller SR, Brooks A, Kariyawasam D, Toschi E, Gonder-Frederick L, Stadler M, Rogers H, Goldsmith K, Choudhary P, de Zoysa N, Amiel SA. Cost-effectiveness of a Novel Hypoglycaemia Programme: The 'HARPdoc vs BGAT' RCT. Diabet Med 2024; 41:e15304. [PMID: 38421806 DOI: 10.1111/dme.15304] [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] [Received: 11/09/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 03/02/2024]
Abstract
AIMS To assess the cost-effectiveness of HARPdoc (Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised care), focussed upon cognitions and motivation, versus BGAT (Blood Glucose Awareness Training), focussed on behaviours and education, as adjunctive treatments for treatment-resistant problematic hypoglycaemia in type 1 diabetes, in a randomised controlled trial. METHODS Eligible adults were randomised to either intervention. Quality of life (QoL, measured using EQ-5D-5L); cost of utilisation of health services (using the adult services utilization schedule, AD-SUS) and of programme implementation and curriculum delivery were measured. A cost-utility analysis was undertaken using quality-adjusted life years (QALYs) as a measure of trial participant outcome and cost-effectiveness was evaluated with reference to the incremental net benefit (INB) of HARPdoc compared to BGAT. RESULTS Over 24 months mean total cost per participant was £194 lower for HARPdoc compared to BGAT (95% CI: -£2498 to £1942). HARPdoc was associated with a mean incremental gain of 0.067 QALYs/participant over 24 months post-randomisation: an equivalent gain of 24 days in full health. The mean INB of HARPdoc compared to BGAT over 24 months was positive: £1521/participant, indicating comparative cost-effectiveness, with an 85% probability of correctly inferring an INB > 0. CONCLUSIONS Addressing health cognitions in people with treatment-resistant hypoglycaemia achieved cost-effectiveness compared to an alternative approach through improved QoL and reduced need for medical services, including hospital admissions. Compared to BGAT, HARPdoc offers a cost-effective adjunct to educational and technological solutions for problematic hypoglycaemia.
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Affiliation(s)
- Andrew Healey
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tayana Soukup
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 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
| | - 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, UK
| | - Samantha Cross
- 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, UK
| | - Simon R Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Augustin Brooks
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Dulmini Kariyawasam
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Elena Toschi
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Linda Gonder-Frederick
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, USA
| | - Marietta Stadler
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
| | - Helen Rogers
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Kimberley Goldsmith
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pratik Choudhary
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Nicole de Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
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9
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Scheuer SH, Andersen GS, Carstensen B, Diaz L, Kosjerina V, Lindekilde N, Wild SH, Jackson CA, Pouwer F, Benros ME, Jørgensen ME. Trends in Incidence of Hospitalization for Hypoglycemia and Diabetic Ketoacidosis in Individuals With Type 1 or Type 2 Diabetes With and Without Severe Mental Illness in Denmark From 1996 to 2020: A Nationwide Study. Diabetes Care 2024; 47:1065-1073. [PMID: 38640020 DOI: 10.2337/dc23-2394] [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] [Received: 12/15/2023] [Accepted: 03/20/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To examine trends in incidence of acute diabetes complications in individuals with type 1 or type 2 diabetes with and without severe mental illness (SMI) in Denmark by age and calendar year. RESEARCH DESIGN AND METHODS We conducted a cohort study using nationwide registers from 1996 to 2020 to identify individuals with diabetes, ascertain SMI status (namely, schizophrenia, bipolar disorder, or major depression) and identify the outcomes: hospitalization for hypoglycemia and diabetic ketoacidosis (DKA). We used Poisson regression to estimate incidence rates (IRs) and incidence rate ratios (IRRs) of recurrent hypoglycemia and DKA events by SMI, age, and calendar year, accounting for sex, diabetes duration, education, and country of origin. RESULTS Among 433,609 individuals with diabetes, 8% had SMI. Risk of (first and subsequent) hypoglycemia events was higher for individuals with SMI than for those without SMI (for first hypoglycemia event, IRR: type 1 diabetes, 1.77 [95% CI 1.56-2.00]; type 2 diabetes, 1.64 [95% CI 1.55-1.74]). Individuals with schizophrenia were particularly at risk for recurrent hypoglycemia events. The risk of first DKA event was higher in individuals with SMI (for first DKA event, IRR: type 1 diabetes, 1.78 [95% CI 1.50-2.11]; type 2 diabetes, 1.85 [95% CI 1.64-2.09]). Except for DKA in the type 2 diabetes group, IR differences between individuals with and without SMI were highest in younger individuals (<50 years old) but stable across the calendar year. CONCLUSIONS SMI is an important risk factor for acute diabetes complication and effective prevention is needed in this population, especially among the younger population and those with schizophrenia.
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Affiliation(s)
| | | | | | - Lars Diaz
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Vanja Kosjerina
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Nanna Lindekilde
- Department of Occupational & Environmental Medicine, Odense University Hospital, Odense, Denmark
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, U.K
| | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Michael E Benros
- Copenhagen Research Centre for Biological and Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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10
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Lin YK, Hepworth E, de Zoysa N, McCurley J, Vajravelu ME, Ye W, Piatt GA, Amiel SA, Fisher SJ, Pop-Busui R, Aikens JE. Relationships of hypoglycemia awareness, hypoglycemia beliefs, and continuous glucose monitoring glycemic profiles with anxiety and depression symptoms in adults with type 1 diabetes using continuous glucose monitoring systems. Diabetes Res Clin Pract 2024; 209:111596. [PMID: 38428746 PMCID: PMC10960959 DOI: 10.1016/j.diabres.2024.111596] [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] [Received: 02/05/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
AIMS To evaluate relationships of hypoglycemia awareness, hypoglycemia beliefs, and continuous glucose monitoring (CGM) glycemic profiles with anxiety and depression symptoms in adults with type 1 diabetes (T1D) who use CGM. METHODS A cross-sectional survey and data collections were completed with 196 T1D adults who used CGM (59% also used automated insulin delivery devices (AIDs)). We assessed hypoglycemia awareness (Gold instrument), hypoglycemia beliefs (Attitudes to Awareness of Hypoglycemia instrument), CGM glycemic profiles, demographics, and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Analysis included simple and multiple linear regression analyses. RESULTS Lower hypoglycemia awareness, weaker "hypoglycemia concerns minimized" beliefs, stronger "hyperglycemia avoidance prioritized" beliefs were independently associated with higher anxiety symptoms (P < 0.05), with similar trends in both subgroups using and not using AIDs. Lower hypoglycemia awareness were independently associated with greater depression symptoms (P < 0.05). In participants not using AIDs, more time in hypoglycemia was related to less anxiety and depression symptoms (P < 0.05). Being female and younger were independently associated with higher anxiety symptoms, while being younger was also independently associated with greater depression symptoms (P < 0.05). CONCLUSION Our findings revealed relationships of impaired hypoglycemia awareness, hypoglycemia beliefs, CGM-detected hypoglycemia with anxiety and depression symptoms in T1D adults who use CGMs.
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Affiliation(s)
- Yu Kuei Lin
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
| | - Emily Hepworth
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Nicole de Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Jessica McCurley
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48105, USA
| | - Gretchen A Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Kings College London, London SE5 9RJ, UK
| | - Simon J Fisher
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40508, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
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11
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Kuei Lin Y, Hepworth E, de Zoysa N, McCurley J, Ellen Vajravelu M, Ye W, Piatt GA, Amiel SA, Fisher SJ, Pop-Busui R, Aikens JE. Associations Between Hypoglycemia Awareness, Hypoglycemia Beliefs, and Continuous Glucose Monitoring Glycemic Profiles and Anxiety and Depression Symptoms in Adults with Type 1 Diabetes Using Advanced Diabetes Technologies. Diabetes Res Clin Pract 2023:111059. [PMID: 38104898 DOI: 10.1016/j.diabres.2023.111059] [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: 11/16/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
AIMS To evaluate relationships between hypoglycemia awareness, hypoglycemia beliefs, and continuous glucose monitoring (CGM) glycemic profiles and anxiety and depression symptoms in adults with type 1 diabetes (T1D) who use CGM or automated insulin delivery devices. METHODS A cross-sectional survey and data collections were completed with 196 T1D adults who used advanced diabetes technologies. We assessed hypoglycemia awareness (Gold instrument), hypoglycemia beliefs (Attitudes to Awareness of Hypoglycemia instrument), CGM glycemic profiles, demographics, and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Data were processed via regression analyses and receiver operating characteristic analyses. RESULTS Lower hypoglycemia awareness, weaker "hypoglycemia concerns minimized" beliefs, stronger "hyperglycemia avoidance prioritized" beliefs, female, and younger age were independently associated with higher anxiety symptoms (P<0.05). Lower hypoglycemia awareness, less time in hypoglycemia, and younger age were independently associated with greater depression symptoms (P<0.05). Age of <50 years had 77.8% sensitivity and 48.8% specificity in detecting elevated anxiety symptoms. Spending ≥35% of time with glucose levels >180 mg/dL on CGMs had 85.7% sensitivity and 54.3% specificity in detecting elevated depression symptoms. CONCLUSION Our findings revealed relationships between impaired hypoglycemia awareness, hypoglycemia beliefs, CGM-detected hypoglycemia and anxiety and depression symptoms in T1D adults who use advanced diabetes technologies.
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Affiliation(s)
- Yu Kuei Lin
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
| | - Emily Hepworth
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Nicole de Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Jessica McCurley
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48105, USA
| | - Gretchen A Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Kings College London, London SE5 9RJ, UK
| | - Simon J Fisher
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40508, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
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12
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Pang J, Zhang L, Li X, Sun F, Qiu J, Zhao Y, Wang J, Liu L, Wan X, Zhang Y. Identification of factors associated with fear of hypoglycemia using the capability, opportunity, motivation and behavior model in people with type 2 diabetes mellitus: a cross-sectional study. Acta Diabetol 2023; 60:1405-1415. [PMID: 37380727 DOI: 10.1007/s00592-023-02132-w] [Citation(s) in RCA: 2] [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: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
AIMS To examined the relationship between fear of hypoglycemia and certain variables in people with type 2 diabetes mellitus (T2DM) based on the Capability, Opportunity, Motivation, and Behavior model, combined with the context unique to people with diabetes to provide a basis for developing targeted nursing interventions. METHODS In this cross-sectional study, 212 people with T2DM were recruited from February 2021 to July 2021. Data were collected using the Hypoglycaemia Fear Survey, Gold score, Patient Assessment of Chronic Illness Care (PACIC) scale and Diabetic Self-Management Attitudes Scale. Multiple linear regression analysis was performed to determine the predictors of fear of hypoglycemia using SPSS 26.0. RESULTS The mean fear of hypoglycemia score was 74.88 ± 18.28 (range: 37.00-132.00). In people with T2DM, the frequency of blood glucose monitoring, the frequency of hypoglycemia in the past half-year, degree of understanding of hypoglycemia, impaired awareness of hypoglycemia, PACIC, and self-management attitude of diabetes were the influencing factors of fear of hypoglycemia (adjusted R2 = 0.560, F[21,190] = 13.800, P < 0.001). These variables explained 56.0% of the variance in the fear of hypoglycemia. CONCLUSIONS The level of fear of hypoglycemia in people with T2DM was relatively high. In addition to paying attention to the disease characteristics of people with T2DM, medical staff should also pay attention to patients' own perception and handling ability of disease and hypoglycemia, attitude toward self-management behavior and external environment support, all of which have a positive effect on improving the fear of hypoglycemia in people with T2DM, optimizing the self-management level and improving quality of life.
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Affiliation(s)
- Juan Pang
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Lu Zhang
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Xiangning Li
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Fenfen Sun
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Jiahui Qiu
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Yueqi Zhao
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Jinping Wang
- Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, China
| | - Lin Liu
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Xiaojuan Wan
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Yu Zhang
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China.
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13
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Yu X, Fan M, Zhao X, Ding Y, Liu X, Yang S, Zhang X. Prevalence of impaired awareness of hypoglycaemia in people with diabetes mellitus: A systematic review and meta-analysis from 21 countries and regions. Diabet Med 2023; 40:e15129. [PMID: 37143390 DOI: 10.1111/dme.15129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
AIMS Impaired awareness of hypoglycaemia (IAH) is a complication of glucose-lowering therapies for diabetes. The purpose of this review was to estimate the pooled prevalence of IAH and unawareness of hypoglycaemia (UAH). METHODS We searched the major databases from inception to 8 August 2022 and included all cross-sectional and cohort studies reporting IAH prevalence in people with diabetes. A random-effects model was used to pool effect values. Subgroup analysis and meta-regression were used to identify study-level characteristics affecting prevalence. RESULTS Sixty-two studies from 21 countries published between 2000 and 2022 were included, with 39,180 participants (type 1 diabetes: 19,304 vs. Type 2 diabetes: 14,650). The pooled prevalence was 23.2% (95% CI: 18.4%-29.3%) via the Clarke questionnaire, 26.2% (95% CI: 22.9%-29.9%) via the Gold score, and 58.5% (95% CI: 53.0%-64.6%) via the Pedersen-Bjergaard method, all from studies classified as presenting a moderate and low risk of bias. The prevalence of IAH was generally higher in people with type 1 diabetes than in those with type 2 diabetes and lowest in Europe. Meta-regression results show that the duration of diabetes was a factor influencing the prevalence of IAH. The prevalence of UAH by the Pedersen-Bjergaard method was 17.6 (95% CI: 14.9%-20.3%). CONCLUSIONS IAH is a prevalent risk event among people with type 1 and type 2 diabetes, showing clinical heterogeneity and regional variability. UAH, an adverse progression of IAH, is also a serious burden. More primary research on the prevalence of IAH is needed in areas with a high diabetes burden.
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Affiliation(s)
- Xiaohui Yu
- School of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Min Fan
- School of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Xia Zhao
- School of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Yanan Ding
- School of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Xueli Liu
- School of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Shengju Yang
- Department of Endocrinology, The First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital), Hefei, Anhui, China
| | - Xinqiong Zhang
- School of Nursing, Anhui Medical University, Hefei, Anhui, China
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14
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Typ-1-Diabetes: beeinträchtigte Hypoglykämiewahrnehmung und psychische Störungen. DIABETOL STOFFWECHS 2023. [DOI: 10.1055/a-1933-5880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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