Original articleImpaired awareness of hypoglycaemia in subjects with type 1 diabetes. Results of an online survey in a diabetes web siteHipoglucemia desapercibida en personas con diabetes tipo 1. Resultados de una encuesta “on line” en una Web de diabetes
Introduction
Hypoglycaemia is the most relevant adverse event related to insulin treatment.1, 2 Repeated episodes of hypoglycaemia in subjects with type 1 diabetes (T1D) may result in failure to recognize hypoglycaemia symptoms and signs at a physiologically normal threshold.3 Impaired awareness of hypoglycaemia (IAH) may occur in up to 20–25% of individuals with T1D and the lack of warning symptoms places them at high risk for severe hypoglycaemia (SH).4, 5 In addition, both IAH and SH represent the main limiting factor to achieve optimal beneficial glycaemic control precluding its beneficial effects.6
In order to identify IAH, different questionnaires and self-report measures are being used in clinical practice.7, 8 Among these, despite some limitations, the Clarke test is one of the most frequently used, providing detailed assessment of IAH.7 This test encompasses eight questions regarding exposure to hypoglycaemia and a subjective estimation of the glycaemic threshold for the generation of symptoms and signs. The use of the Clarke questionnaire which was conceived in English requires its validation in a different language before its use in clinical practice and research purposes in non-English speaking populations.
We recently conducted and published the psychometric validation of the Clarke questionnaire in two different languages, Spanish and Catalan.9 In our study, we sought to evaluate the frequency of IAH using the Spanish version of the Clarke test in a free access diabetes-related web portal.
Section snippets
Patients and methods
We collected (March 2014–January 2015 inclusive) anonymous data from a free access Spanish version of the Clarke test previously uploaded in the website of the Fundación para la Diabetes (http://www.fundaciondiabetes.org/encuestas/box_encuesta_clarke.htm). This is a free access web portal for patients and health care professionals. In addition to the eight questions included in the questionnaire, on a previous page we asked for information regarding the type of diabetes (T1D, T2D, other types
Results
Only those with T1D diabetes (418) were included in the analysis, with 51.2% being in the 36–55 years of age range. Regarding disease duration, 34.7% had had T1D for more than 15 years; 20.6% between 11 and 15 years; 17.2% between 2 and 5 years; 16.5% between 6 and 10 years and in only 11% subjects, T1D had been diagnosed less than 2 years before. We found the presence of IAH in 23.4% of questionnaires. Uncertain awareness was found in 15.3% and normal awareness of hypoglycaemia was found in
Discussion
According to an online survey using the Spanish version of the Clarke questionnaire we found that up to ∼25% of adult participants with T1D have IAH and that the prevalence of this condition increases with the duration of the disease.
Data regarding the prevalence of IAH in Spain are still very scarce in comparison with other countries. This is probably due, at least in part, to the infrequent use of specific questionnaires dedicated to the detection of IAH mainly because of the lack of
Conflict of interest
The authors declare no conflict of interest regarding the manuscript.
Acknowledgements
We are indebted to all of those who participated in the survey and to the personnel from the “Fundación para la Diabetes” for their help.
References (16)
Hypoglycemia: still the limiting factor in the glycemic management of diabetes
Endocr Pract
(2008)- et al.
[Psychometric analysis of the Spanish and Catalan versions of a questionnaire for hypoglycemia awareness]
Med Clin (Barc)
(2015) Hypoglycemia in the Diabetes Control and Complications Trial. The Diabetes Control and Complications Trial Research Group
Diabetes
(1997)- et al.
Hypoglycaemia in adults with insulin-treated diabetes in the UK: self-reported frequency and effects
Diabet Med
(2015) Mechanisms of hypoglycemia-associated autonomic failure in diabetes
N Engl J Med
(2013)- et al.
Prevalence of impaired awareness of hypoglycaemia in adults with Type 1 diabetes
Diabet Med
(2008) - et al.
Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia
Diabetes Care
(1994) - et al.
Reduced awareness of hypoglycemia in adults with IDDM. A prospective study of hypoglycemic frequency and associated symptoms
Diabetes Care
(1995)
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Prevalence of severe hypoglycemia in a cohort of patients with type 1 diabetes
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2018, NeuropharmacologyCitation Excerpt :“Hypoglycemia unawareness” is defined as “syndromes of defective glucose counterregulation and hypoglycemia without warning symptoms” (Cryer, 2004). This increases the risk of both symptomatic and asymptomatic hypoglycemia manifested in diabetics under intensive anti-diabetic therapy (Amiel et al., 1988; Bolli et al., 1984; Clarke et al., 1995; Conget et al., 2016; Cryer, 2006; White et al., 1983). Previously, we observed that a prior exposure to moderate RH increases cerebral ischemic brain damage in insulin-treated diabetic (ITD) rats (Dave et al., 2011b).
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