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Changes in attitudes to awareness of hypoglycaemia during a hypoglycaemia awareness restoration programme are associated with avoidance of further severe hypoglycaemia episodes within 24 months: the A2A in HypoCOMPaSS study

Lookup NU author(s): Professor James Shaw



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022, The Author(s). Aims/hypothesis: The aims of this study were to assess cognitions relating to hypoglycaemia in adults with type 1 diabetes and impaired awareness of hypoglycaemia before and after the multimodal HypoCOMPaSS intervention, and to determine cognitive predictors of incomplete response (one or more severe hypoglycaemic episodes over 24 months). Methods: This analysis included 91 adults with type 1 diabetes and impaired awareness of hypoglycaemia who completed the Attitudes to Awareness of Hypoglycaemia (A2A) questionnaire before, 24 weeks and 24 months after the intervention, which comprised a short psycho-educational programme with optimisation of insulin therapy and glucose monitoring. Results: The age and diabetes duration of the participants were 48±12 and 29±12 years, respectively (mean±SD). At baseline, 91% reported one or more severe hypoglycaemic episodes over the preceding 12 months; this decreased to <20% at 24 weeks and after 24 months (p=0.001). The attitudinal barrier ‘hyperglycaemia avoidance prioritised’ (η2p=0.250, p=0.001) decreased from baseline to 24 weeks, and this decrease was maintained at 24 months (mean±SD=5.3±0.3 vs 4.3±0.3 vs 4.0±0.3). The decrease in ‘asymptomatic hypoglycaemia normalised’ from baseline (η2p=0.113, p=0.045) was significant at 24 weeks (1.5±0.3 vs 0.8±0.2). Predictors of incomplete hypoglycaemia response (one or more further episodes of severe hypoglycaemia) were higher baseline rates of severe hypoglycaemia, higher baseline scores for ‘asymptomatic hypoglycaemia normalised’, reduced change in ‘asymptomatic hypoglycaemia normalised’ scores at 24 weeks, and lower baseline ‘hypoglycaemia concern minimised’ scores (all p<0.05). Conclusions/interpretation: Participation in the HypoCOMPaSS RCT was associated with improvements in hypoglycaemia-associated cognitions, with ‘hyperglycaemia avoidance prioritised’ most prevalent. Incomplete prevention of subsequent severe hypoglycaemia episodes was associated with persistence of the cognition ‘asymptomatic hypoglycaemia normalised’. Understanding and addressing cognitive barriers to hypoglycaemia avoidance is important in individuals prone to severe hypoglycaemia episodes. Clinical trials registration: ISRCTN52164803 and EudraCT2009-015396-27. Graphical abstract: [Figure not available: see fulltext.].

Publication metadata

Author(s): Sepulveda E, Jacob P, Poinhos R, Carvalho D, Vicente SG, Smith EL, Shaw JAM, Speight J, Choudhary P, de Zoysa N, Amiel SA

Publication type: Article

Publication status: Published

Journal: Diabetologia

Year: 2023

Volume: 66

Pages: 631-641

Print publication date: 01/04/2023

Online publication date: 20/12/2022

Acceptance date: 06/10/2022

Date deposited: 23/06/2023

ISSN (print): 0012-186X

ISSN (electronic): 1432-0428

Publisher: Springer Science and Business Media Deutschland GmbH


DOI: 10.1007/s00125-022-05847-7

PubMed id: 36538062


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Funder referenceFunder name
07/0003556Diabetes UK
Albert Renold Fellowship, European Foundation for the Study of Diabetes
Australian Centre for Behavioural Research in Diabetes
Cambridge National Institute for Health Research Biomedical Research Centre
National Institute for Health Research Newcastle Biomedical Research Centre