title: The impact of non-severe hypoglycemic events on daytime function and diabetes management among adults with type 1 and type 2 diabetes.
abstract: OBJECTIVE
  To describe daytime non-severe hypoglycemic events (NSHEs), assess their impact on patient functioning and diabetes self-management, and examine if these impacts differ by diabetes type or country.
  
  
  METHODS
  Internet survey to adults with diabetes in the US, UK, Germany, and France.
  
  
  RESULTS
  Of 6756 screened respondents, 2439 reported a daytime NSHE in the past month. NSHEs occurred while active (e.g., running errands) (45.1%), 29.6% while not active (e.g., watching TV), and 23.8% at work. On average, it took half a day to respond and recover from NSHE. Respondents monitored their glucose 5.7 extra times on average over the following week. On the day of event, type 1 respondents tested significantly more often than type 2 (p<0.05). Type 2 were less likely to confirm NSHE with glucose test (p<0.001). Following NSHE, 12.6% of respondents reduced total insulin by an average of 7.6 units (SD=8.3). Total units and days with reduced dosing was significantly less, whilst number of additional glucose tests and time to recover was significantly longer if NSHE occurred at work (p<0.001). Type 1 decreased insulin doses more often (p<0.001); however, type 2 decreased a greater number of units (p<0.01). Compared with other countries, US respondents were more likely to eat a light or full meal and respondents in France took significantly longer than all other countries to recognize (p<0.05), respond to (p<0.001), and recover from (p<0.001) NSHE, used significantly more monitoring tests the day of (p<0.05) and over the subsequent week (p<0.001), and decreased their normal insulin dose more (p<0.001). Limitations of the study include potential recall bias and selection bias.
  
  
  CONCLUSIONS
  NSHEs are associated with a significant impact on patient functioning and diabetes management.
authors.affiliation: The Brod Group, Mill Valley, CA 94941, USA. mbrod@thebrodgroup.net
authors.forename: Meryl
authors.initials: M
authors.lastname: Brod
authors.forename: Torsten
authors.initials: T
authors.lastname: Christensen
authors.forename: Donald M
authors.initials: DM
authors.lastname: Bushnell
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D007003:Hypoglycemia / Q000191:economics* / Q000453:epidemiology / Q000503:physiopathology*; D020407:Internet; D008297:Male; D008875:Middle Aged; D012648:Self Care; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology