Abstract：
Impaired awareness of hypoglycaemia (IAH) has been associated with increased diabetes distress and use of sensor technology can reduce diabetes distress. The aim of this study was to examine diabetes-specific distress (emotions, cognitions, behaviours) in relation to IAH status and use of glucose sensors in people with type 1 diabetes.
Individuals with type 1 diabetes from an academic diabetes outpatient clinic completed the Clarke questionnaire (to assess hypoglycaemic awareness), Problem Areas in Diabetes (PAID-5), Hypoglycaemia Fear Survey-II (HFS-II), Attitudes to Awareness of Hypoglycaemia Survey (A2A), Nijmegen Clinical Screening Instrument Survey (NCSI) and Hyperglycaemia Avoidance Scale (HAS).
Of the 422 participants (51.9% male, diabetes duration 30 [16-40] years, HbA1c 60 ± 11 mmol/mol [7.6 ± 1.0%], 351 [88.2%] used a glucose sensor; 82 [19.4%]) had IAH. Compared to individuals with normal awareness, those with IAH more often had PAID-5 scores ≥8 (35.4% vs. 21.5%, p = 0.008) and higher scores on all HFS-II subscores (total [40.2 ± 21.5 vs. 27.9 ± 17.2, p < 0.001]), HFS-II behaviour (18.5 ± 10.0 vs. 15.1 ± 8.0, p = 0.005), HFS-II worry (21.8 ± 13.5 vs. 12.7 ± 10.9, p < 0.001), HAS worries (17.5 ± 7.3 vs. 14.3 ± 7.0, p < 0.001) and NCSI hypoglycaemia items. HAS behaviour, A2A and NCSI hyperglycaemia scores did not differ between individuals with or without IAH. Restricting the analyses to individuals using a glucose sensor did not materially change the results.
Diabetes-specific distress remains a major problem among individuals with type 1 diabetes, particularly those with IAH, despite the widespread use of (intermittently scanned) sensor technology. Further studies are needed to examine strategies to lower diabetes-specific distress in individuals with IAH.
Individuals with type 1 diabetes from an academic diabetes outpatient clinic completed the Clarke questionnaire (to assess hypoglycaemic awareness), Problem Areas in Diabetes (PAID-5), Hypoglycaemia Fear Survey-II (HFS-II), Attitudes to Awareness of Hypoglycaemia Survey (A2A), Nijmegen Clinical Screening Instrument Survey (NCSI) and Hyperglycaemia Avoidance Scale (HAS).
Of the 422 participants (51.9% male, diabetes duration 30 [16-40] years, HbA1c 60 ± 11 mmol/mol [7.6 ± 1.0%], 351 [88.2%] used a glucose sensor; 82 [19.4%]) had IAH. Compared to individuals with normal awareness, those with IAH more often had PAID-5 scores ≥8 (35.4% vs. 21.5%, p = 0.008) and higher scores on all HFS-II subscores (total [40.2 ± 21.5 vs. 27.9 ± 17.2, p < 0.001]), HFS-II behaviour (18.5 ± 10.0 vs. 15.1 ± 8.0, p = 0.005), HFS-II worry (21.8 ± 13.5 vs. 12.7 ± 10.9, p < 0.001), HAS worries (17.5 ± 7.3 vs. 14.3 ± 7.0, p < 0.001) and NCSI hypoglycaemia items. HAS behaviour, A2A and NCSI hyperglycaemia scores did not differ between individuals with or without IAH. Restricting the analyses to individuals using a glucose sensor did not materially change the results.
Diabetes-specific distress remains a major problem among individuals with type 1 diabetes, particularly those with IAH, despite the widespread use of (intermittently scanned) sensor technology. Further studies are needed to examine strategies to lower diabetes-specific distress in individuals with IAH.
摘要：
目的：低血糖（IAH）意识受损与糖尿病困扰增加有关，使用传感器技术可以减少糖尿病困扰。这项研究的目的是检查糖尿病特有的痛苦(情绪，认知，行为）与1型糖尿病患者的IAH状态和葡萄糖传感器的使用有关。
方法：来自学术糖尿病门诊诊所的1型糖尿病患者填写了Clarke问卷（评估低血糖意识），糖尿病问题领域（PAID-5）低血糖恐惧调查-II（HFS-II），对低血糖调查意识的态度(A2A)，奈梅亨临床筛查仪器调查（NCSI）和避免高血糖量表（HAS）。
结果：在422名参与者中（51.9%为男性，糖尿病病程30[16-40]年，HbA1c60±11mmol/mol[7.6±1.0%]，351[88.2%]使用葡萄糖传感器;82[19.4%])具有IAH。与意识正常的人相比，IAH患者的PAID-5得分≥8（35.4%与21.5%,p=0.008）和所有HFS-II子分数的更高分数（总计[40.2±21.5vs.27.9±17.2，p<0.001])，HFS-II行为（18.5±10.0与15.1±8.0，p=0.005)，HFS-II担心（21.8±13.5vs.12.7±10.9，p<0.001），有担忧（17.5±7.3vs.14.3±7.0，p<0.001）和NCSI低血糖项目。有行为，A2A和NCSI高血糖评分在有或没有IAH的个体之间没有差异。使用葡萄糖传感器将分析限于个体并没有实质性地改变结果。
结论：糖尿病特异性困扰仍然是1型糖尿病患者的主要问题，尤其是那些有IAH的人，尽管广泛使用（间歇性扫描）传感器技术。需要进一步的研究来研究降低IAH患者糖尿病特异性痛苦的策略。
方法：来自学术糖尿病门诊诊所的1型糖尿病患者填写了Clarke问卷（评估低血糖意识），糖尿病问题领域（PAID-5）低血糖恐惧调查-II（HFS-II），对低血糖调查意识的态度(A2A)，奈梅亨临床筛查仪器调查（NCSI）和避免高血糖量表（HAS）。
结果：在422名参与者中（51.9%为男性，糖尿病病程30[16-40]年，HbA1c60±11mmol/mol[7.6±1.0%]，351[88.2%]使用葡萄糖传感器;82[19.4%])具有IAH。与意识正常的人相比，IAH患者的PAID-5得分≥8（35.4%与21.5%,p=0.008）和所有HFS-II子分数的更高分数（总计[40.2±21.5vs.27.9±17.2，p<0.001])，HFS-II行为（18.5±10.0与15.1±8.0，p=0.005)，HFS-II担心（21.8±13.5vs.12.7±10.9，p<0.001），有担忧（17.5±7.3vs.14.3±7.0，p<0.001）和NCSI低血糖项目。有行为，A2A和NCSI高血糖评分在有或没有IAH的个体之间没有差异。使用葡萄糖传感器将分析限于个体并没有实质性地改变结果。
结论：糖尿病特异性困扰仍然是1型糖尿病患者的主要问题，尤其是那些有IAH的人，尽管广泛使用（间歇性扫描）传感器技术。需要进一步的研究来研究降低IAH患者糖尿病特异性痛苦的策略。
