Characterising impaired awareness of hypoglycaemia and associated risks through HypoA-Q: findings from a T1D Exchange cohort,Diabetologia

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Characterising impaired awareness of hypoglycaemia and associated risks through HypoA-Q: findings from a T1D Exchange cohort
Diabetologia ( IF 8.4 ) Pub Date : 2024-10-30 , DOI: 10.1007/s00125-024-06310-5
Yu Kuei Lin, Wen Ye, Emily Hepworth, Annika Agni, Austin M. Matus, Anneliese J. Flatt, James A. M. Shaw, Michael R. Rickels, Stephanie A. Amiel, Jane Speight

Aims/hypothesis

We aimed to: (1) externally validate the five-item Hypoglycaemia Awareness Questionnaire (HypoA-Q) impaired awareness subscale (HypoA-Q IA); (2) examine how impaired awareness of hypoglycaemia (IAH) relates to the risk of severe hypoglycaemia and level 2 hypoglycaemia; and (3) identify factors associated with IAH.

Methods

Nationwide survey of T1D Exchange registrants was conducted to collect data on demographics, 6 month severe-hypoglycaemia history, hypoglycaemia awareness status (via HypoA-Q IA, the Gold instrument and the Clarke instrument) and continuous glucose monitor (CGM) measures. The Clarke hypoglycaemia awareness factor (Clarke-HAF) was calculated to exclude severe-hypoglycaemia history items. Analyses included Cronbach’s α, Spearman correlations and logistic regression.

Results

Valid survey responses were collected from N=1580 adults with type 1 diabetes (median age, 44 years; 52% female participants; median HbA_1c, 48 mmol/mol [6.5%]). Of these, 94% of participants were using CGMs and 69% were using hybrid closed-loop (HCL) systems; 30% had at least one severe-hypoglycaemia episode in the past 6 months. The HypoA-Q IA had satisfactory internal reliability (α=0.79) and construct validity. Higher HypoA-Q IA scores were independently associated with greater risk of severe hypoglycaemia (p<0.001), performing comparably to the Gold instrument and the Clarke-HAF instrument. HypoA-Q IA-determined IAH was independently associated with 88% higher odds of developing severe hypoglycaemia (p<0.001) and twofold higher odds for spending ≥1% of time in level 2 hypoglycaemia (p=0.011). Higher age and longer diabetes duration were associated with higher IAH risk (p<0.001). CGM and HCL use was associated with lower IAH risk (p<0.001).

Conclusions/interpretation

The HypoA-Q IA is a brief, valid and reliable tool for assessing IAH in today’s technology-oriented era. IAH was independently associated with severe hypoglycaemia and level 2 hypoglycaemia in a cohort with high prevalence of advanced diabetes technology use and HbA_1c within the recommended range. CGM and HCL use was related to lower IAH risk.

Graphical Abstract

中文翻译：

通过 HypoA-Q 表征对低血糖和相关风险的认识受损：来自 T1D 交换队列的结果

目标/假设

我们的目标是：（1）外部验证五项低血糖意识问卷（HypoA-Q）意识障碍分量表（HypoA-Q IA）;（2）检查低血糖意识受损（IAH）与严重低血糖和 2 级低血糖风险的关系;（3）确定与 IAH 相关的因素。

方法

对 T1D 交换注册者进行了全国调查，以收集有关人口统计学、6 个月严重低血糖病史、低血糖意识状态（通过 HypoA-Q IA、Gold 工具和 Clarke 仪器）和连续血糖监测仪（CGM）测量的数据。计算 Clarke 低血糖意识因子（Clarke-HAF）以排除严重低血糖病史项目。分析包括 Cronbach α、Spearman 相关性和 logistic 回归。

结果

从 N=1580 名患有 1 型糖尿病的成年人（中位年龄 44 岁;52% 的女性参与者;中位 HbA_1c，48 mmol/mol [6.5%]）中收集了有效的调查回复。其中，94% 的参与者正在使用 CGM，69% 的参与者正在使用混合闭环（HCL）系统;30% 的患者在过去 6 个月内至少有一次重度低血糖发作。HypoA-Q IA 具有令人满意的内部信度（α=0.79）和结构效度。较高的 HypoA-Q IA 评分与严重低血糖风险的增加独立相关（p<0.001），与 Gold 工具和 Clarke-HAF 工具的表现相当。HypoA-Q IA 确定的 IAH 与发生严重低血糖的几率高 88% （p<0.001）和在 2 级低血糖中花费 ≥1% 时间的几率高两倍独立相关（p=0.011）。年龄较大、糖尿病病程较长与 IAH 风险较高相关（p<0.001）。CGM 和 HCL 的使用与较低的 IAH 风险相关（p<0.001）。