How problematic hypoglycaemia compromises quality of life — ASN Events
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How problematic hypoglycaemia compromises quality of life (#44)

Christel Hendrieckx 1 2 , Jennifer A Halliday 1 2 , Peter Colman 3 4 , Neale Cohen 5 , Alicia Jenkins 6 7 , Jane Speight 1 2 8
  1. Medtronic, Northridge, United States
  2. Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia
  3. Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
  4. Department of Diabetes and Endocrinology, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
  5. Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
  6. Department of Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
  7. NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
  8. AHP Research, Hornchurch, Essex, UK

AIM
To investigate prevalence of fear of hypoglycaemia (FoH) in adults with type 1 diabetes (T1D) and its association with severe hypoglycaemia (SH) and impaired awareness of hypoglycaemia (IAH).

METHODS
Participants completed a survey while waiting for a routine appointment at one of three Melbourne diabetes specialist clinics. FoH was assessed with the Hypoglycaemia Fear Survey (HFS), including a 15-item behaviour scale (HFS-B) measuring actions to avoid hypoglycaemia, and an 18-item worry scale (HFS-W) measuring concerns about hypoglycaemia. Composite scale scores were the sum of item scores (range: 0 (never) to 4 (often)) divided by the number of items. Elevated FoH was defined as HFS-B and/or HFS-W scale scores ≥ mean+1SD. We also measured self-reported occurrence of SH (≥1 event in the past six months) and IAH (using the Gold score). Results are mean±SD.

RESULTS
Adults with T1D (n=427; age 38±15yrs; 53% women; diabetes duration 18±12 yrs) participated. The HFS-B and HFS-W scores were 1.2±0.5 and 1.1±0.7 respectively, with 24% having elevated FoH. Participants reporting SH and/or IAH (n=125, 30%) had greater FoH (HFS-B 1.3±0.6; HFS-W 1.4±0.7) vs. those without SH and/or IAH (n=287, 70%) (HFS-B 1.1±0.5; HFS-W 0.9±0.7; p<0.001). More specifically, participants experiencing SH and/or IAH scored higher on HFS-B items referring to behaviours compromising quality of life (e.g. limiting activities, increasing dependence on others) than those without SH and/or IAH. However, HFS-B items indicating changes in BG management to avoid low glucose levels (e.g. eating large snacks) were similar. Frequency of SH correlated positively with FoH (HFS-W r=0.29; HFS-B r=0.17, p<0.01).

CONCLUSIONS
Our findings showed low levels of FoH in adults with T1D attending a diabetes specialist clinic, with 24% having elevated FoH. FoH was associated with SH and IAH. Participants reporting SH and/or IAH  applied behavioural strategies likely to impair their quality of life and to increase their reliance on others.

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