Diabetes distress remains greater in patients with T1D and impaired awareness of hypoglycemia

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Diabetes-related distress remains a persistent problem among people with type 1 diabetes (T1D), especially those with cognitive impairment to hypoglycemia (IAH), according to a new study.1

Frequent use of continuous glucose monitoring (CGM) technology does not appear to weaken the association of hypoglycemia with impaired awareness and distress, highlighting the need for further approaches to adequately eliminate diabetic distress. is suggested.

A research team led by Namam Ali, Department of Internal Medicine, Radboud University Medical Center, wrote, “Despite the great concern about IAH, patients with IAH were less motivated and had less confidence in recovery.” “The use of sensor technology appeared to reduce the association between IAH and diabetic-specific distress, but distress appeared to be reduced in individuals who recovered from IAH after introduction of the glucose sensor.”

Previous literature has shown that hypoglycemia is common among T1D patients as a potentially unavoidable complication of insulin therapy. For such a person, recurrent hypoglycemia may induce residency, which may eventually lead him to IAH.2 The research team notes that patients with T1D and IAH may experience high levels of diabetes-specific distress as a result of coping with the needs and limitations associated with their chronic disease.

Patients with IAH are at increased risk of severe hypoglycemia events, which may result in greater diabetic distress, increased stress over these events, and increased fear of hypoglycemia. The use of CGM has also been shown to reduce diabetes-specific distress, associated with both improved glycemic outcomes and reduced incidence of hypoglycemia. For this analysis, Ali et al. investigated diabetes-specific distress (emotional, cognitive , behavior).1

This single-center, cross-sectional study was conducted from February 2020 to April 2021 at the Diabetes Outpatient Clinic at Radboud University Medical Center in T1D patients aged 16 years and older. Of the 702 patients with his T1D who were evaluated for eligibility, 422 were enrolled in the study (51.9% male, 30-year diabetes duration). Participants completed the Hypoglycemia Awareness Status, Diabetes Problem Areas (PAID-5), Hypoglycemia Fear Survey II (HFS-II), Attitudes to Hypoglycemia Awareness Survey (A2A), and the Nijmegen Clinical Screening Instruments Survey (NCSI). I completed the Clarke survey to evaluate. , and Hyperglycemic Avoidance Scale (HAS).

Approximately 88% of study participants reported a median duration of glucose sensor use of 12 months, and 19.4% of participants reported IAH (n = 82). Upon analysis, the researchers observed that high levels of diabetes-related distress (PAID-5 score of 8 or higher) were present in 24.2% (n = 102) of individuals. Data showed that high scores were more common in he IAH patients compared with NAH patients (35.4% vs. 21.5%; P. = .008), and patients with IAH have higher PAID-5 total scores.

Analysis showed that IAH participants also scored higher on all HFS-II subscores (P. <.001), including HFS behavior (P. = .005), HFS-II concerns (P. <.001), there is concern (P. <.001), and NCSI hypoglycemia items. However, HAS behavior, A2A, and NCSI hyperglycemia scores were not found to differ between individuals with and without IAH. Sensitivity analyzes revealed that diabetes-specific distress questionnaire results were broadly similar when restricted to participants using CGM technology.

“Apparently, despite the widespread use of CGM technology, this gap between IAH and NAH has not been closed,” the researchers wrote. “Further research is needed to investigate psychological or technical intervention strategies to reduce diabetes-specific distress, especially in people with residual IAH despite sensor use.”


  1. Ali N, El Hamdawi S, Nefs G, Walberg Schmidt JWJ, Tak CJ, De Garan BE.High diabetes-specific distress and impaired awareness of hypoglycemia in adults with type 1 diabetes despite widespread use of sensor technology [published online ahead of print, 2023 Jun 22]. diabetes medicine. 2023; e15167. Doi: 10.1111/dme.15167
  2. McNealy AD, McCrimmon RJ. Cognitive Impairment of Hypoglycemia in Type 1 Diabetes: Lessons from the Lab Diabetes. 2018; 61(4): 743-750.

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