medwireNews: People with type 1 diabetes are more likely to have impaired awareness of hypoglycemia (IAH) if they also report symptoms of anxiety and depression, UK study findings indicate.
Writing in Diabetes Care, Sufyan Hussain (King’s College London) and co-authors say that the “robust independent relationship between probable anxiety and depression with IAH demonstrates the need for routine psychological assessment and management of people with type 1 diabetes and IAH.”
Their cross-sectional observational study identified IAH, defined as a Clarke score of 4 points or higher, in 22.6% of the 950 participants.
Probable generalized anxiety disorder (Generalized Anxiety Disorder-7 score ≥10 points) was prevalent in 9.4%, while 9.8% had probable major depressive disorder according to Patient Health Questionnaire-9 criteria.
The researchers report that significantly more participants with versus without IAH met the criteria for anxiety (14.9 vs. 7.8%), depression (18.1 vs. 7.4%), or both (11.2 vs 4.8%).
After adjusting for sociodemographic and clinical characteristics, Hussain and team found that both probable anxiety and depression were significantly and independently associated with an increased likelihood of IAH, at odds ratios of 2.46 and 3.64, respectively.
Further analysis showed that the risk for IAH increased with worsening severity of anxiety and depression.
Hussain et al note that their study “does not establish causality,” but say that anxiety and depression “could lead to altered behavior or motivations in diabetes self-care, increasing the risk for hypoglycemia and, consequently, IAH.”
They add that difficulty discriminating between symptoms of anxiety and hypoglycemia might contribute to IAH by delaying hypoglycemia treatment, while recurrent hypoglycemia and/or IAH could negatively impact quality of life and emotions.
The investigators conclude that their findings “support a recent report that measuring mental health and providing psychological interventions alongside education could achieve overall best outcomes in IAH.”
They say: “Future research may provide further insights into the mechanisms underlying the relationship and whether integrated mental health programs in people with type 1 diabetes and IAH may help to reverse IAH and/or improve mental health.”
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