Abstract
Objective: To (1) externally validate the HypoA-Q’s 5-item impaired awareness subscale (IA); (2) examine how impaired awareness of hypoglycemia (IAH) relates to the risk of severe hypoglycemia (SH) and Level 2 hypoglycemia; and (3) identify factors associated with IAH.
Research Design and Methods: Nationwide survey of T1D Exchange registrants was conducted to collect demographics, 6-month SH history, hypoglycemia awareness status (HypoA-Q IA, Gold and Clarke instruments), and continuous glucose monitor (CGM) measures. The Clarke hypoglycemia awareness factor (“Clarke-HAF”) was calculated to exclude SH history items. Analyses included Cronbach’s α, Spearman correlations, and logistic regression.
Results: Valid survey responses were collected from N=1,580 adults with T1D (median age: 44, 52% female; median hemoglobin A1C: 48 mmol/mol [6.5%]). Of these, 94% of participants were using CGMs and 69% were using hybrid closed-loop systems (HCLs); 30% had at least one SH episode in the past six months. The HypoA-Q IA scale had satisfactory internal reliability (α=0.79) and construct validity. Higher HypoA-Q IA scores were independently associated with greater SH risk (P<0.001), performing comparably to the Gold and Clarke-HAF. HypoA-Q IA–determined IAH was independently associated with 88% higher odds of developing SH (P<0.001) and 2-fold higher odds for spending ≥1% of time in Level 2 hypoglycemia (P=0.011). CGM and HCL use was associated with lower IAH risk (P<0.001).
Conclusions: HypoA-Q IA is a brief, valid and reliable tool for assessing IAH in today’s technology-oriented era. IAH is independently associated with SH and Level 2 hypoglycemia in a cohort with high prevalence of advanced diabetes technology use and HbA1c within recommended range. CGM and HCL use was related to lower IAH risk.
Research Design and Methods: Nationwide survey of T1D Exchange registrants was conducted to collect demographics, 6-month SH history, hypoglycemia awareness status (HypoA-Q IA, Gold and Clarke instruments), and continuous glucose monitor (CGM) measures. The Clarke hypoglycemia awareness factor (“Clarke-HAF”) was calculated to exclude SH history items. Analyses included Cronbach’s α, Spearman correlations, and logistic regression.
Results: Valid survey responses were collected from N=1,580 adults with T1D (median age: 44, 52% female; median hemoglobin A1C: 48 mmol/mol [6.5%]). Of these, 94% of participants were using CGMs and 69% were using hybrid closed-loop systems (HCLs); 30% had at least one SH episode in the past six months. The HypoA-Q IA scale had satisfactory internal reliability (α=0.79) and construct validity. Higher HypoA-Q IA scores were independently associated with greater SH risk (P<0.001), performing comparably to the Gold and Clarke-HAF. HypoA-Q IA–determined IAH was independently associated with 88% higher odds of developing SH (P<0.001) and 2-fold higher odds for spending ≥1% of time in Level 2 hypoglycemia (P=0.011). CGM and HCL use was associated with lower IAH risk (P<0.001).
Conclusions: HypoA-Q IA is a brief, valid and reliable tool for assessing IAH in today’s technology-oriented era. IAH is independently associated with SH and Level 2 hypoglycemia in a cohort with high prevalence of advanced diabetes technology use and HbA1c within recommended range. CGM and HCL use was related to lower IAH risk.
| Original language | English |
|---|---|
| Journal | Diabetologia |
| Publication status | Accepted/In press - 17 Sept 2024 |
