Amelia J Cook1, Stephanie N DuBose2, Nicole Foster2, Emma L Smith1, Mengdi Wu2, Georgina Margiotta1, Michael R Rickels3, Jane Speight4,5,6, Nicole de Zoysa1, Stephanie A Amiel7,8. 1. Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, U.K. 2. Jaeb Center for Health Research, Tampa, FL. 3. Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 4. School of Psychology, Deakin University, Geelong, Victoria, Australia. 5. The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia. 6. AHP Research, Essex, U.K. 7. Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, U.K. stephanie.amiel@kcl.ac.uk. 8. Institute of Diabetes, Obesity and Endocrinology, King's Health Partners, London, U.K.
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.
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.
Authors: Peter Jacob; Munachiso Nwokolo; Sally M Cordon; Ian A Macdonald; Fernando O Zelaya; Stephanie A Amiel; Owen O'Daly; Pratik Choudhary Journal: J Cereb Blood Flow Metab Date: 2022-02-25 Impact factor: 6.960
Authors: Yu Kuei Lin; Caroline R Richardson; Iulia Dobrin; Melissa J DeJonckheere; Kara Mizokami-Stout; Michael D Fetters; James E Aikens; Simon J Fisher; Wen Ye; Rodica Pop-Busui Journal: Diabetes Care Date: 2022-03-01 Impact factor: 19.112
Authors: Ioannis Bakolis; Nicole de Zoysa; Stephanie A Amiel; Laura Potts; Kimberley Goldsmith; Peter Jacob; Emma L Smith; Linda Gonder-Frederick; Simon Heller; Elena Toschi; Augustin Brooks; Dulmini Kariyawasam; Pratik Choudhary; Marietta Stadler; Helen Rogers; Mike Kendall; Nick Sevdalis Journal: Nat Commun Date: 2022-04-28 Impact factor: 17.694
Authors: Yu Kuei Lin; Danielle Groat; Owen Chan; Man Hung; Anu Sharma; Michael W Varner; Ramkiran Gouripeddi; Julio C Facelli; Simon J Fisher Journal: Diabetes Technol Ther Date: 2020-10-13 Impact factor: 6.118
Authors: Peter Jacob; Laura Potts; Rory H Maclean; Nicole de Zoysa; Helen Rogers; Linda Gonder-Frederick; Emma L Smith; Dulmini Kariyawasam; Augustin Brooks; Simon Heller; Elena Toschi; Mike Kendall; Ioannis Bakolis; Pratik Choudhary; Kimberley Goldsmith; Stephanie A Amiel Journal: Diabetologia Date: 2022-03-24 Impact factor: 10.460
Authors: Rory H Maclean; Peter Jacob; Pratik Choudhary; Simon R Heller; Elena Toschi; Dulmini Kariyawasam; Augustin Brooks; Mike Kendall; Nicole de Zoysa; Linda A Gonder-Frederick; Stephanie A Amiel Journal: Diabetes Care Date: 2022-03-01 Impact factor: 19.112