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01-26-2022 | Continuous glucose monitoring | News

Personal beliefs may underlie persistent hypoglycemia in CGM users

Author: Laura Cowen

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medwireNews: Individuals with type 1 diabetes continue to experience severe and level 2 hypoglycemia despite the use of continuous glucose monitoring (CGM) systems, with the risk potentially influenced by personal beliefs, US research shows.

Writing in Diabetes Care, Yu Kuei Lin (University of Michigan, Ann Arbor) and co-authors say their study “provides evidence that human behaviors continue to affect hypoglycemia outcomes in individuals with type 1 diabetes despite the implementation of advanced diabetes technologies.”

The analysis included survey data for 289 adults (mean age 45 years, 65% women) with type 1 diabetes who had been using CGM for at least 6 months (92% >1 year). Of these, 80% were using an insulin pump, including 61% with a closed-loop feature. A third of participants presented with impaired hypoglycemia awareness based on the Gold score.

The researchers report that 25.6% of participants had experienced at least one severe hypoglycemic episode, defined as an episode requiring assistance, in the 6 months prior to the survey.

These individuals had significantly higher glycated hemoglobin (HbA1c), average CGM glucose levels, Gold scores (ie, lower hypoglycemia awareness), and glycemic variability than those without severe hypoglycemia but there was no difference between the two groups in several other baseline variables including use of an insulin pump, time spent in hypoglycemia, and the use of hypoglycemia alarms.

According to the Attitude to Awareness of Hypoglycemia questionnaire, individuals with severe hypoglycemia had significantly higher summary scores on beliefs surrounding hyperglycemia avoidance than those without severe hypoglycemia.

Specifically, severe hypoglycemia was associated with significantly higher scores on the statements “I get frustrated and/or worried when I see high blood glucose readings,” “good diabetes control is mainly about avoiding high blood glucose levels,” and “sometimes I know I am giving myself more insulin than I really need.”

In addition, 13.6% of participants had spent at least 1% of time over 4 weeks in the previous 3 months in significant level 2 hypoglycemia, defined as blood glucose levels below 54 mg/dL (3.0 mmol/L).

These individuals did not have higher risks for developing severe hypoglycemia than those without significant level 2 hypoglycemia, but they did have significantly lower mean HbA1c and CGM glucose levels, and higher Gold scores and glycemic variability. They also spent more time in hypoglycemia and were more likely to turn off hypoglycemia alarms.

In terms of beliefs, individuals with significant level 2 hypoglycemia reported significantly higher summary scores on beliefs minimizing hypoglycemia concerns, and specifically for the statements “there are no serious consequences to leaving mild hypoglycemia untreated” and “I can function okay with low blood glucose levels.”

Lin et al note however that the mean scores on most beliefs were often below 50% of the maximum, which they say suggests “that the beliefs do not need to be strong to indicate high risks for developing severe or significant level 2 hypoglycemia.”

They add: “This information could inform future behavioral intervention research, because it also implies that a small reduction in the belief scores may generate clinically significant benefits in terms of reducing hypoglycemia.”

The authors conclude that “advanced diabetes technologies alone do not help all individuals with type 1 diabetes eliminate severe hypoglycemia or reach hypoglycemia glucose goals.”

Furthermore “while some risk factors for developing severe and significant level 2 hypoglycemia differ, [impaired hypoglycemia awareness] and high glucose variability continue to be associated with both of these dangerous hypoglycemic conditions.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Diabetes Care 2022; doi:10.2337/dc21-1285

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