Severe hypoglycemia, impaired awareness of hypoglycemia, and self-monitoring in adults with type 1 diabetes: Results from Diabetes MILES-Australia.
AIMS
To assess prevalence of severe hypoglycemia, awareness and symptoms of hypoglycemia, and their associations with self-monitoring of blood glucose.


METHODS
Diabetes MILES-Australia Study participants completed validated questionnaires and study-specific items.


RESULTS
Of 642 adults with type 1 diabetes, 21% reported ≥1 severe hypoglycemic event in the past six months, and 21% reported impaired awareness of hypoglycemia (IAH). Severe hypoglycemia was increased four-fold for those with IAH compared with intact awareness (1.4±3.9 versus 0.3±1.0). Of those with IAH, 92% perceived autonomic and 88% neuroglycopenic symptoms, albeit at lower glucose thresholds compared to people with intact awareness. Those with IAH were more likely to perceive both symptom types at the same glucose level or to perceive neuroglycopenic symptoms first (all p<0.001). Eighteen percent with IAH treated hypoglycemia only when they perceived symptoms and another 18% only when their capillary glucose was <3.0mmol/L.


CONCLUSIONS
One in five adults with type 1 diabetes had IAH or experienced severe hypoglycemia in the past sixmonths. Total loss of hypoglycemia symptoms was rare; most people with IAH retained autonomic symptoms, perceived at relatively low glucose levels. Frequent self-monitoring of blood glucose prompted early recognition and treatment of hypoglycemia, suggesting severe hypoglycemia risk can be minimized.
['Hendrieckx|Christel|C|', 'Hagger|Virginia|V|', 'Jenkins|Alicia|A|', 'Skinner|Timothy Chas|TC|', 'Pouwer|Frans|F|', 'Speight|Jane|J|']
D000328:Adult D001315:Australia D015190:Blood Glucose Self-Monitoring D060825:Cognitive Dysfunction D015331:Cohort Studies D003131:Combined Modality Therapy D003922:Diabetes Mellitus, Type 1 D059026:Diagnostic Self Evaluation D005260:Female D007722:Health Knowledge, Attitudes, Practice D006306:Health Surveys D006801:Humans D007003:Hypoglycemia D008297:Male D008875:Middle Aged D010349:Patient Compliance D015995:Prevalence D012306:Risk D057566:Self Report D000073278:Self-Management D012720:Severity of Illness Index
Severe hypoglycemia Impaired awareness of hypoglycemia Type 1 diabetes Self-monitoring of blood glucose Symptom recognition