title: The impact of severe hypoglycemia and impaired awareness of hypoglycemia on relatives of patients with type 1 diabetes.
abstract: OBJECTIVE
  Severe hypoglycemia is a major problem for patients with type 1 diabetes and their relatives. The aim of this study was to compare patients' and relatives' assessments of rates of severe hypoglycemia and state of awareness and to explore the influence on involvement and concern of relatives.
  
  
  METHODS
  A cross-sectional paired questionnaire survey on hypoglycemia and the state of awareness was used in our study comprising 284 unselected adult patients with type 1 diabetes and their closest cohabitant. The cohabitant questionnaires also addressed involvement and concern.
  
  
  RESULTS
  The agreement between assessments of rates of severe hypoglycemia and state of awareness made by patients and cohabitants was weak (kappa 0.404 and 0.442, respectively; P < 0.001). Cohabitants recalled more episodes of severe hypoglycemia than patients (2.7 vs. 1.6 episodes/patient-year; P < 0.001). Degree of involvement was positively related to the rate of severe hypoglycemia (P = 0.002) and negatively related to the state of awareness (P = 0.007) but not to level of HbA(1c), duration of diabetes, or presence of late complications, except for peripheral neuropathy (P = 0.01).
  
  
  CONCLUSIONS
  Cohabitants of patients with type 1 diabetes recall significantly more episodes of severe hypoglycemia than the patients. The rate of severe hypoglycemia and state of hypoglycemic awareness are the principal determinants of degree of cohabitants' involvement in their partners' disease.
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark. hvj@jyde.dk
authors.forename: Hanne V
authors.initials: HV
authors.lastname: Jørgensen
authors.forename: Ulrik
authors.initials: U
authors.lastname: Pedersen-Bjergaard
authors.forename: Ase K
authors.initials: AK
authors.lastname: Rasmussen
authors.forename: Knut
authors.initials: K
authors.lastname: Borch-Johnsen
mesh_terms: D000328:Adult; D017668:Age of Onset; D001294:Attitude to Health; D001364:Awareness / Q000502:physiology*; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000503:physiopathology / Q000523:psychology*; D005190:Family; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000503:physiopathology* / Q000523:psychology; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D010045:Outpatients; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin