In the Journals

Hypoglycemia increases psychological, diabetes distress levels

Adults with diabetes who have experienced hypoglycemia report a lower quality of life, worse psychological health and more diabetes distress compared with those who have not, according to findings published in Nutrition, Metabolism and Cardiovascular Diseases.

“Hypoglycemia is generally perceived as an inevitable price to pay to achieve the HbA1c goal,” Maria Chiara Rossi, MSCPharmChem, of the Center for Outcomes Research and Clinical Epidemiology in Pescara, Italy, and colleagues wrote. “Nevertheless, hypoglycemia is responsible for increased risk of cardiovascular events, fractures, cognitive impairment and mortality. Hypoglycemia is associated with high direct and indirect costs for health care systems and citizens. It also exerts a negative impact on quality of life and can interfere with a wide range of daily activities.”

Rossi and colleagues conducted an observational retrospective study with 2,023 adults with type 2 diabetes (mean age, 66.3 years; 44.7% women) and 206 adults with type 1 diabetes (mean age, 42.4 years; 52.7% women) who were consecutively recruited at diabetes outpatient clinics in Italy. Participants completed questionnaires in which they detailed severe hypoglycemic events in the last year and symptomatic events in the previous month and also evaluated their psychological health, diabetes distress, general health and fear of hypoglycemia.

Participants with type 2 diabetes who had either a severe hypoglycemic event in the previous year or a symptomatic event in the previous month had lower reported measures of general health and psychological health and more diabetes distress and fear of hypoglycemia compared with those who did not have such events (P < .05 for all). Similarly, participants with type 1 diabetes and a severe hypoglycemic event had lower reported measures of general health and psychological health and more diabetes distress and fear of hypoglycemia compared with those without (P < .05 for all), but the association did not hold for those with recent symptomatic events.

The questionnaire that evaluated fear of hypoglycemia had a 100-point scale, and those with a score of more than 25 were considered to have the most fear. These participants had higher HbA1c and worse scores in questionnaires assessing diabetes distress, as well as general and psychological health compared with those with lower scores (P < .0001 for all). Participants were more likely to have a score of more than 25 on this questionnaire if they were women (OR = 1.55; 95% CI, 1.24-1.95), had a severe hypoglycemic event in the previous year (OR = 2.17; 95% CI, 1.43-3.29) or any year (OR = 1.59; 95% CI, 1.18-2.14), used insulin (OR = 1.88; 95% CI, 1.51-2.35) or had at least a high school education (OR = 1.27; 95% CI, 1.01-1.61), the researchers wrote.

“The study has important implications, since it clearly documents that even symptomatic episodes of hypoglycemia exert a negative effect on quality of life. These findings are particularly important considering the elevated frequency of such episodes,” the researchers wrote. “Developing educational programs targeted on reduction of fear of hypoglycemia, in addition to effective and safe therapeutic strategies, may represent a specific and effective intervention to minimize the impact of hypoglycemia on the lives of people with diabetes.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.

Adults with diabetes who have experienced hypoglycemia report a lower quality of life, worse psychological health and more diabetes distress compared with those who have not, according to findings published in Nutrition, Metabolism and Cardiovascular Diseases.

“Hypoglycemia is generally perceived as an inevitable price to pay to achieve the HbA1c goal,” Maria Chiara Rossi, MSCPharmChem, of the Center for Outcomes Research and Clinical Epidemiology in Pescara, Italy, and colleagues wrote. “Nevertheless, hypoglycemia is responsible for increased risk of cardiovascular events, fractures, cognitive impairment and mortality. Hypoglycemia is associated with high direct and indirect costs for health care systems and citizens. It also exerts a negative impact on quality of life and can interfere with a wide range of daily activities.”

Rossi and colleagues conducted an observational retrospective study with 2,023 adults with type 2 diabetes (mean age, 66.3 years; 44.7% women) and 206 adults with type 1 diabetes (mean age, 42.4 years; 52.7% women) who were consecutively recruited at diabetes outpatient clinics in Italy. Participants completed questionnaires in which they detailed severe hypoglycemic events in the last year and symptomatic events in the previous month and also evaluated their psychological health, diabetes distress, general health and fear of hypoglycemia.

Participants with type 2 diabetes who had either a severe hypoglycemic event in the previous year or a symptomatic event in the previous month had lower reported measures of general health and psychological health and more diabetes distress and fear of hypoglycemia compared with those who did not have such events (P < .05 for all). Similarly, participants with type 1 diabetes and a severe hypoglycemic event had lower reported measures of general health and psychological health and more diabetes distress and fear of hypoglycemia compared with those without (P < .05 for all), but the association did not hold for those with recent symptomatic events.

The questionnaire that evaluated fear of hypoglycemia had a 100-point scale, and those with a score of more than 25 were considered to have the most fear. These participants had higher HbA1c and worse scores in questionnaires assessing diabetes distress, as well as general and psychological health compared with those with lower scores (P < .0001 for all). Participants were more likely to have a score of more than 25 on this questionnaire if they were women (OR = 1.55; 95% CI, 1.24-1.95), had a severe hypoglycemic event in the previous year (OR = 2.17; 95% CI, 1.43-3.29) or any year (OR = 1.59; 95% CI, 1.18-2.14), used insulin (OR = 1.88; 95% CI, 1.51-2.35) or had at least a high school education (OR = 1.27; 95% CI, 1.01-1.61), the researchers wrote.

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“The study has important implications, since it clearly documents that even symptomatic episodes of hypoglycemia exert a negative effect on quality of life. These findings are particularly important considering the elevated frequency of such episodes,” the researchers wrote. “Developing educational programs targeted on reduction of fear of hypoglycemia, in addition to effective and safe therapeutic strategies, may represent a specific and effective intervention to minimize the impact of hypoglycemia on the lives of people with diabetes.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.