Conversations and Reactions Around Severe Hypoglycemia (CRASH): Japan Results From a Global Survey of People with T1DM or Insulin-Treated T2DM and Caregivers

Abstract

Aims: The CRASH study examined severe hypoglycemia (SH) experiences among people with diabetes (PWD) and caregivers across eight countries. Here we report findings from the Japan cohort, with references to data from the United Kingdom (UK) cohort. Materials and Methods: Adults with type 1 (T1DM) or insulin-treated type 2 diabetes mellitus (T2DM) and caregivers (not necessarily related) were recruited from online patient panels. Participants who had experienced at least one SH event in the past 3 years were eligible for study inclusion. Participants completed an online survey regarding their experience with SH, its treatment, and actions during and after an event.Results: Of the 9367 PWD and caregivers from the online patient panels, 8475 participants were ineligible and a total of 53 Japanese participants (35 T1DM, 9 T2DM, 9 caregivers) completed the survey. Most SH incidents occurred at home and were unattended by a healthcare provider. For T1DM, 29% of Japan PWD and 13% of the UK PWD called an ambulance during an SH event; of these, 90% (Japan) and 50% (UK) were transported to hospital. Glucagon use was low (3% Japan and 10% UK for T1DM). Japanese respondents reported emotional impacts of SH, including feeling scared (86% T1DM, 56% T2DM), unprepared (63% T1DM, 78% T2DM), and helpless (60% T1DM, 33% T2DM). Despite the emotional burden, most PWD did not immediately discuss their SH event with a healthcare provider, with the majority (75% T1DM, 71% T2DM) waiting until their next doctor's appointment. Conclusion:Conversations around SH between healthcare providers and PWD appear to be insufficient in Japan. An emotional burden of SH was reported by PWD and caregivers. Education regarding the prevention of SH and available treatment options may reduce SH events and improve treatment preparation, while alleviating PWD concerns.

Severe Hypoglycemia and the Use of Glucagon Rescue Agents: An Observational Survey in Adults With Type 1 Diabetes

“…Importantly, the survey highlighted the emotional burden of SH on those affected, showing a considerable proportion of participants expressing worry or concern (67.7%), fear (54.4%), panic (52.5%), embarrassment (50.6%), and shame (21.2%) in connection with SH events. These findings are reflective of the findings of other recent survey studies on the negative emotional impact of SH on individuals with type 1 diabetes ( 39 – 43 ).…”

“…Participants reported being aware of their hypoglycemia episodes primarily by experiencing symptoms and through the use of CGM; however, a substantial proportion (44.6%) reported impaired awareness of hypoglycemia. A high prevalence of hypoglycemia unawareness, even in those using CGM, has previously been reported; yet, the result from this survey was slightly higher than the rates noted in people with type 1 diabetes in other studies ( 39 , 40 , 42 , 44 , 45 ).…”

“…Approximately half of the most recent SH events occurred in the 6 months immediately before the survey, emphasizing the relative frequency with which SH episodes occurred in the surveyed sample. The data on SH events in the 12 months before survey completion align with recent surveys of individuals with type 1 diabetes in other countries that reported means of 1.5–4.2 SH events in the previous 12 months ( 39 , 40 ). Importantly, CGM users among the surveyed sample continued to experience SH events, albeit fewer than non-CGM users.…”

“…Nocturnal hypoglycemia and hypoglycemia during or after exercise were concerns for approximately three-fourths of the participants. Although we did not measure how often participants experienced nocturnal or exercise-related hypoglycemia, current research supports our participants’ concerns, indicating that 28.7–51.4% of participants’ most recent SH events occurred during the night ( 39 , 40 , 42 ). Both nocturnal hypoglycemia and exercise-related hypoglycemia are associated with immediate clinical consequences ( 46 , 47 ).…”

“…Participants who had never received a glucagon prescription ( n = 9) stated that the main reasons for this were that their doctor had never discussed it with them, they carried oral carbohydrates with them, or they relied on CGM. A global survey report suggests differences among countries regarding the proportion of individuals with type 1 diabetes who were unable to have glucagon administered during an SH event because they did not have a glucagon prescription or it was not filled ( 39 , 40 , 42 ), ranging from 25.0% in a French cohort ( 42 ) to 68.8% in a Japanese cohort ( 39 ).…”