What do patients with type 1 diabetes know about hypoglycaemia?

Abstract

Our concern was that some patients do not fully understand hypoglycaemia and as a result mismanage episodes. A self-completed questionnaire was administered to 125 type 1 diabetes patients attending for a routine appointment. 75 respondents (mean age 52.5, range 18±78; 44% male, 56% female) answered questions related to identi®cation, treatment and access to information regarding hypoglycaemia. The results show that a signi®cant proportion of the group were unable to identify 4 mmol/L as the starting point of hypoglycaemia. Only 24% correctly treated hypoglycaemia with short and long acting carbohydrate. 6% gave inappropriate choices of food. 57% exclusively ate short acting carbohydrate to treat their symptoms. 80% identi®ed warning symptoms. 17% reported solely autonomic symptoms whilst 40% reported autonomic coupled with nueroglycopenic. Despite only 4% receiving no information at all, patients with diabetes are still failing to correctly identify and treat hypoglycaemic episodes. The main responsibility to improve and support behaviour with respect to hypoglycaemia lies with the health professionals involved in diabetes care, in partnership with patients. Recommendations are to modify information given to patients to ensure equal emphasis to short and long acting carbohydrate for the treatment of hypoglycaemia and to approach manufacturers to update their literature to re¯ect this.

Self‐treatment of mild symptomatic hypoglycaemia by people with insulin‐treated diabetes

“…In support of this explanation, the elderly subgroup (> 70 years of age) and those with Type 2 diabetes performed less well on the diabetes knowledge questionnaire ( r = 0.23, P < 0.05 for initial treatment; r = 0.20, P < 0.05 for follow‐up treatment; r = 0.30, P < 0.005 for overall treatment), despite having similar psychometric intelligence scores to younger respondents, and they undertreated hypoglycaemia more commonly. This is consistent with the demonstration in a previous study of deficiencies in knowledge of the self‐management of hypoglycaemia by people with Type 1 diabetes [8], and with other studies that have shown that diabetes knowledge is particularly deficient in elderly people [9–11].…”

The diabetes educator: trying hard, but must concentrate more on behaviour

“…While most agree on the merits of education, many people with diabetes are not benefiting from it [9]. In the UK, only one‐quarter of patients with Type 1 diabetes could explain what is meant by the appropriate use of short‐ and long‐acting carbohydrate to treat hypoglycaemia [10]. Other studies have also been published supporting widespread knowledge deficits [11–13].…”

Factors associated with knowledge level in adult type 1 diabetic patients

“…Thus, a better level of knowledge would ensure better self-management of diabetes. However, some authors demonstrated the absence of a relationship between knowledge and the practical aspect of management of the disease ("Knowledge-behavior gap") [7,13,20,21]. The link between knowledge and practice depends on several factors related to the patient, his immediate environment, health professionals, and the care structure.…”