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Characterising impaired awareness of hypoglycaemia and associated risks through HypoA-Q: findings from a T1D Exchange cohort

Lookup NU author(s): Professor James ShawORCiD

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Abstract

© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.Aims/hypothesis: We aimed to: (1) externally validate the five-item Hypoglycaemia Awareness Questionnaire (HypoA-Q) impaired awareness subscale (HypoA-Q IA); (2) examine how impaired awareness of hypoglycaemia (IAH) relates to the risk of severe hypoglycaemia and level 2 hypoglycaemia; and (3) identify factors associated with IAH. Methods: Nationwide survey of T1D Exchange registrants was conducted to collect data on demographics, 6 month severe-hypoglycaemia history, hypoglycaemia awareness status (via HypoA-Q IA, the Gold instrument and the Clarke instrument) and continuous glucose monitor (CGM) measures. The Clarke hypoglycaemia awareness factor (Clarke-HAF) was calculated to exclude severe-hypoglycaemia history items. Analyses included Cronbach’s α, Spearman correlations and logistic regression. Results: Valid survey responses were collected from N=1580 adults with type 1 diabetes (median age, 44 years; 52% female participants; median HbA1c, 48 mmol/mol [6.5%]). Of these, 94% of participants were using CGMs and 69% were using hybrid closed-loop (HCL) systems; 30% had at least one severe-hypoglycaemia episode in the past 6 months. The HypoA-Q IA had satisfactory internal reliability (α=0.79) and construct validity. Higher HypoA-Q IA scores were independently associated with greater risk of severe hypoglycaemia (p<0.001), performing comparably to the Gold instrument and the Clarke-HAF instrument. HypoA-Q IA-determined IAH was independently associated with 88% higher odds of developing severe hypoglycaemia (p<0.001) and twofold higher odds for spending ≥1% of time in level 2 hypoglycaemia (p=0.011). Higher age and longer diabetes duration were associated with higher IAH risk (p<0.001). CGM and HCL use was associated with lower IAH risk (p<0.001). Conclusions/interpretation: The HypoA-Q IA is a brief, valid and reliable tool for assessing IAH in today’s technology-oriented era. IAH was independently associated with severe hypoglycaemia and level 2 hypoglycaemia in a cohort with high prevalence of advanced diabetes technology use and HbA1c within the recommended range. CGM and HCL use was related to lower IAH risk. Graphical Abstract: (Figure presented.)

Publication metadata

Author(s): Lin YK, Ye W, Hepworth E, Agni A, Matus AM, Flatt AJ, Shaw JAM, Rickels MR, Amiel SA, Speight J

Publication type: Article

Publication status: Published

Journal: Diabetologia

Year: 2024

Pages: epub ahead of print

Online publication date: 30/10/2024

Acceptance date: 17/09/2024

ISSN (print): 0012-186X

ISSN (electronic): 1432-0428

Publisher: Springer Science and Business Media Deutschland GmbH

URL: https://doi.org/10.1007/s00125-024-06310-5

DOI: 10.1007/s00125-024-06310-5

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