New insights into the currently available questionnaire for assessing impaired awareness of hypoglycaemia (IAH) among insulin-treated type 2 diabetes- A key risk factor for hypoglycaemia

Li, Ang; Bee, Yong Mong; Goh, Su-Yen; Teh, Ming

doi:10.1016/j.deman.2023.100136

Cited by 2 publications

(8 citation statements)

References 23 publications

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“…Several questionnaires have been developed to assist the diagnosis of IAH. The Gold Score is a hypoglycemia questionnaire in which subjects are asked a single question, “Do you know when your hypoglycemic episodes are commencing?” ( Gold et al, 1994 ; Ang et al, 2023 ). The patient responds using a 7-point Likert scale where one to two denotes awareness, 3 is equivocal, and four to seven indicates unawareness ( Gold et al, 1994 ).…”

Section: Diagnosis Of Impaired Awareness Of Hypoglycemiamentioning

confidence: 99%

“…The patient responds using a 7-point Likert scale where one to two denotes awareness, 3 is equivocal, and four to seven indicates unawareness ( Gold et al, 1994 ). The Clark Score is a more multi-dimensional survey which consists of eight questions that are used to achieve objective answers regarding awareness of hypoglycemia ( Clarke et al, 1995 ; Ang et al, 2023 ). With a score range from 0 to 7, a response total of 4 or above indicates IAH ( Clarke et al, 1995 ; Lin et al, 2019 ; Ang et al, 2023 ).…”

Section: Diagnosis Of Impaired Awareness Of Hypoglycemiamentioning

confidence: 99%

“…The Clark Score is a more multi-dimensional survey which consists of eight questions that are used to achieve objective answers regarding awareness of hypoglycemia ( Clarke et al, 1995 ; Ang et al, 2023 ). With a score range from 0 to 7, a response total of 4 or above indicates IAH ( Clarke et al, 1995 ; Lin et al, 2019 ; Ang et al, 2023 ). The Pedersen-Bjergaard questionnaire asks patients to recall their previous experiences with hypoglycemia and asses their ability to recognize symptoms of hypoglycemia ( Pedersen-Bjergaard et al, 2003 ).…”

Section: Diagnosis Of Impaired Awareness Of Hypoglycemiamentioning

confidence: 99%

“…HypoA-Q is a more recently developed hypoglycemia assessment instrument that is used to characterize IAH and allow for “a more definitive diagnosis of IAH” ( Speight et al, 2016 ). Since the IAH questionnaires vary, some discrepancies can arise such as overestimating impaired awareness in populations that may still have awareness intact, thus leading to the apparent failure of some studies to detect significant improvements in response to clinical interventions ( Sepulveda et al, 2020 ; Ghandi et al, 2021 ; Ang et al, 2023 ).…”

Section: Diagnosis Of Impaired Awareness Of Hypoglycemiamentioning

confidence: 99%

“…In addition, these questionnaires have been validated and adapted to populations beyond their original demographic ( Alkhatatbeh et al, 2019 ; Yosef, 2021 ; Takagi et al, 2022a ). Added benefits for these questionnaires include them being flexible to meet a large sample size ( Sepulveda et al, 2020 ; Ghandi et al, 2021 ; Takagi et al, 2022a ; Ang et al, 2023 ). More recent studies also demonstrate that patients with IAH diagnosed by questionnaires continue to experience higher risks of severe hypoglycemia ( Lin et al, 2019 ; Lin et al, 2022 ).…”

Section: Diagnosis Of Impaired Awareness Of Hypoglycemiamentioning

confidence: 99%

See 4 more Smart Citations

Current and future therapies to treat impaired awareness of hypoglycemia

Macon,

Devore,

Lin

et al. 2023

Front. Pharmacol.

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In order to achieve optimal glycemic control, intensive insulin regimes are needed for individuals with Type 1 Diabetes (T1D) and insulin-dependent Type 2 Diabetes (T2D). Unfortunately, intensive glycemic control often results in insulin-induced hypoglycemia. Moreover, recurrent episodes of hypoglycemia result in both the loss of the characteristic warning symptoms associated with hypoglycemia and an attenuated counterregulatory hormone responses. The blunting of warning symptoms is known as impaired awareness of hypoglycemia (IAH). Together, IAH and the loss of the hormonal response is termed hypoglycemia associated autonomic failure (HAAF). IAH is prevalent in up to 25% in people with T1D and up to 10% in people with T2D. IAH and HAAF increase the risk of severe hypoglycemia 6-fold and 25-fold, respectively. To reduce this risk for severe hypoglycemia, multiple different therapeutic approaches are being explored that could improve awareness of hypoglycemia. Current therapies to improve awareness of hypoglycemia include patient education and psychoeducation, the use of novel glycemic control technology, pancreas/islet transplantation, and drug therapy. This review examines both existing therapies and potential therapies that are in pre-clinical testing. Novel treatments that improve awareness of hypoglycemia, via improving the counterregulatory hormone responses or improving hypoglycemic symptom recognition, would also shed light on the possible neurological mechanisms that lead to the development of IAH. To reduce the risk of severe hypoglycemia in people with diabetes, elucidating the mechanism behind IAH, as well as developing targeted therapies is currently an unmet need for those that suffer from IAH.

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Section: Diagnosis Of Impaired Awareness Of Hypoglycemiamentioning

confidence: 99%