Differentiating Hypoglycemia Awareness Status from Hypoglycemia Experience in Tools for Measuring Impaired Awareness of Hypoglycemia

Abstract

Background: Developing technologies in real-time continuous glucose monitoring (CGM) are successfully reducing severe hypoglycemia (SH) in trials and clinical practice. Their impact on impaired awareness of hypoglycemia, a major risk factor for SH, is uncertain. Methods: The present study examined two scales for assessing hypoglycemia awareness status, the Gold score and the eight-item Minimally Modified Clarke Hypoglycemia Survey (MMCHS), commonly used in trials of CGM, in Portuguese-speaking adults with type 1 diabetes and conducted an exploratory factor analysis on MMCHS. Results: A bifactorial structure in MMCHS was revealed, with a clear distinction between items that measure SH experience and those that measure hypoglycemia awareness status. The latter is associated with the same risk for SH as the Gold score. Conclusions: We conclude that improvement in awareness scores by the MMCHS may reflect only a reduction in SH with no restoration of endogenous awareness, making the current literature consistent in evidence that CGM does not improve endogenous awareness and nonsensor supported protection from SH. This has implications for risk of SH when CGM is not being worn.

Patients with highly unstable type 1 diabetes eligible for islet transplantation can be managed with a closed‐loop insulin delivery system: A series of N‐of‐1 randomized controlled trials

“…On the other hand, some of our patients have reported improvements in their perception of hypoglycaemic symptoms after a few days in closed‐loop periods, feelings which faded quickly during the open‐loop periods. It is therefore important to investigate whether hypoglycaemia awareness is durably restored by closed‐loop DBLHU 30 . This would require further explorations with behavioural research, psychoeducational strategies and brain MRI 31,32 …”

“…It is therefore important to investigate whether hypoglycaemia awareness is durably restored by closed-loop DBLHU. 30 This would require further explorations with behavioural research, psychoeducational strategies and brain MRI. 31,32 Compared with the standard Diabeloop DBLG1 system, 10,11 the DBLHU system allows a higher number of modifications to the command settings, which makes it adaptable to various metabolic phenotypes.…”

Epidemiological, Social and Economic Burden of Severe Hypoglycaemia in Patients with Diabetes Mellitus in Portugal: A Structured Literature Review

“…Almost all records (11 out of 12) were published between 2016 and 2021 [ 11 , 22 – 31 ]. Of the 12 studies included in this review, only 2 [ 26 , 27 ] investigated SHEs in patients with T1DM. In the remaining studies, three focused on T2DM [ 24 , 25 ] and seven reported data on both T1DM and T2DM [ 11 , 23 , 25 , 28 , 30 – 32 ].…”

“…Each study was conducted in a healthcare setting, although the type of setting varied between studies; emergency hospital setting was the most common [ 24 , 25 , 28 , 30 ], followed by a hospital ward [ 11 , 23 , 29 ], emergency and resuscitation medical vehicle unit [ 31 , 32 ], hospital-based diabetes clinic [ 26 , 27 ] and community pharmacy [ 25 ]. Five studies were based on data collected across multiple centres [ 11 , 23 – 25 ], with the number of centres ranging from EDs within 7 hospitals [ 24 ] to 233 community pharmacies [ 25 ].…”

Impaired awareness of hypoglycaemia

“…7 It is less subjective than the Gold score and less well established in the literature, although the association with risk for severe hypoglycaemia is at least as strong. 5 The more complex but very well validated Clarke score measures hypoglycaemia experience as well as awareness status, 10,11 and other scoring systems are used in research. 12,13,14 IAH and its attendant increase in risk for severe hypoglycaemia has been demonstrated to be stressful for partners and family members.…”