medwireNews: People with type 1 diabetes who are “hyperglycemia aversive” reduce their hyperglycemia exposure at the cost of increased hypoglycemia and, potentially, reduced hypoglycemia awareness, research suggests.
The study authors recruited 219 users of Dexcom continuous glucose monitors, who were largely White (89%) and female (69%). They note that, in contrast to the well-established issue of hypoglycemia avoidance, there is no currently accepted method to detect hyperglycemia averseness.
The team, led by Bill Polonsky (Behavioral Diabetes Institute, San Diego, California, USA), used the following three statements to indicate/measure hyperglycemia aversiveness:
- I would rather deal with hypoglycemic episodes (low glucose) than with glucoses that are too high;
- I would rather undertreat hypoglycemic episodes (low glucose) than risk high glucose numbers later;
- I am more worried about the dangers of high glucose than about the dangers of low glucose.
In all, 48.0% of the study participants agreed or strongly agreed with one or two of these statements, and 16.4% endorsed all three and were classed as hyperglycemia aversive.
“For these individuals, frequent hypoglycemia, along with its accompanying risks, may be a tolerable necessity as long as it helps them to feel ‘safe’ from worrisomely high glucose levels and the consequent risk of long-term complications,” write the researchers in the Journal of Diabetes and its Complications.
These people had similar demographic characteristics to other study participants. However, they spent significantly more time in hypoglycemia, at an average of 5.1% versus 2.2% for time below 70 mg/dL (3.9 mmol/L) and 1.2% versus 0.3% for time below 54 mg/dL (3.0 mmol/L).
They more often had recurrent severe hypoglycemia (33.3 vs 14.2%) and impaired hypoglycemia awareness (47.2 vs 25.1%).
The researchers note that frequent hypoglycemic episodes can lead to impaired awareness, and suggest this may be the case for people with hyperglycemia averseness, although they stress that their study cannot prove causality.
“Despite these seemingly negative costs, there was no evidence that [hyperglycemia aversive people] are significantly more distressed than others,” say Polonsky and team.
Participants with hyperglycemia averseness had similar scores for measurements of wellbeing, general life stress, and diabetes distress to those without.
“These findings are consistent with our clinical experience, where individuals who are aiming for unreasonably low glucose levels and are suffering the severe consequences of repeated episodes of severe hypoglycemia rarely seem bothered by their circumstances,” say the researchers.
“Rather, they see themselves as acting appropriately towards achieving their chief aim (avoiding long-term complications), and are willing to accept the tradeoff of frequent hypoglycemia. Due to this sense of personal accomplishment as well as their presumed level of comfort with hypoglycemia, these individuals may be resistant to considering any change in their glucose management preferences.”
On the positive side, hyperglycemia averse people had a significantly higher time in range (average 71.6 vs 63.6%) and lower time in hyperglycemia (6.0 vs 10.1%) than the other participants.
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J Diabetes Complications 2021; doi:10.1016/j.jdiacomp.2021.107925