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Characterizing problematic hypoglycaemia: iterative design and preliminary psychometric validation of the Hypoglycaemia Awareness Questionnaire (HypoA-Q)

Lookup NU author(s): Dr Stuart Little, Professor James Shaw


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AimsTo design and conduct preliminary validation of a measure of hypoglycaemia awareness and problematic hypoglycaemia, the Hypoglycaemia Awareness Questionnaire.MethodsExploratory and cognitive debriefing interviews were conducted with 17 adults (nine of whom were women) with Type 1 diabetes (meansd age 4810years). Questionnaire items were modified in consultation with diabetologists/psychologists. Psychometric validation was undertaken using data from 120 adults (53 women) with Type 1 diabetes (meansd age 4416years; 50% with clinically diagnosed impaired awareness of hypoglycaemia), who completed the following questionnaires: the Hypoglycaemia Awareness Questionnaire, the Gold score, the Clarke questionnaire and the Problem Areas in Diabetes questionnaire.ResultsIterative design resulted in 33 items eliciting responses about awareness of hypoglycaemia when awake/asleep and hypoglycaemia frequency, severity and impact (healthcare utilization). Psychometric analysis identified three subscales reflecting impaired awareness', symptom level' and symptom frequency'. Convergent validity was indicated by strong correlations between the impaired awareness' subscale and existing measures of awareness: (Gold: r(s)=0.75, P<0.01; Clarke: r(s)=0.76, P<0.01). Divergent validity was indicated by weaker correlations with diabetes-related distress (Problem Areas in Diabetes: r(s)=0.25, P<0.01) and HbA(1c) (r(s)=-0.05, non-significant). The impaired awareness' subscale and other items discriminated between those with impaired and intact awareness (Gold score). The impaired awareness' subscale and other items contributed significantly to models explaining the occurrence of severe hypoglycaemia and hypoglycaemia when asleep.ConclusionsThis preliminary validation shows the Hypoglycaemia Awareness Questionnaire has robust face and content validity; satisfactory structure; internal reliability; convergent, divergent and known groups validity. The impaired awareness subscale and other items contribute significantly to models explaining recall of severe and nocturnal hypoglycaemia. Prospective validation, including determination of a threshold to identify impaired awareness, is now warranted.

Publication metadata

Author(s): Speight J, Barendse SM, Singh H, Little SA, Inkster B, Frier BM, Heller SR, Rutter MK, Shaw JAM

Publication type: Article

Publication status: Published

Journal: Diabetic Medicine

Year: 2016

Volume: 33

Issue: 3

Pages: 376-385

Print publication date: 01/03/2016

Online publication date: 14/07/2015

Acceptance date: 01/06/2015

ISSN (print): 0742-3071

ISSN (electronic): 1464-5491

Publisher: Wiley-Blackwell


DOI: 10.1111/dme.12824


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Funder referenceFunder name
07/0003556Diabetes UK