title: Fear of hypoglycaemia in patients with type 1 diabetes: do patients and diabetologists feel the same way?
abstract: OBJECTIVE
  This study described and compared the perception of hypoglycaemia in both patients with type 1 diabetes and diabetologists.
  
  
  METHODS
  This was an observational cross-sectional study undertaken in France in 2011. Data for what hypoglycaemia represents and practices related to it were collected using a questionnaire completed by patients with type 1 diabetes (all>12 years of age) and their diabetologists. Agreement between patients and physicians was evaluated by the intraclass correlation coefficient (ICC) and Gwet's coefficient (GC).
  
  
  RESULTS
  A total of 485 patients were enrolled by 118 diabetologists. Half the patients thought that hypoglycaemia was always symptomatic. According to both patients and diabetologists, hypoglycaemia impaired quality of life, caused anxiety and was disturbing, especially at night. Clinical symptoms of hypoglycaemia (sweating, shakiness, anxiety) were linked to patient's age and diabetes duration. Regarding hypoglycaemia frequency, agreement was good for severe hypoglycaemia (GC: 0.61 and 0.72 for diurnal and nocturnal hypoglycaemia, respectively) and poor for mild hypoglycaemia (ICC: 0.44 and 0.40, respectively). Diabetologists correctly evaluated the impact of hypoglycaemia on quality of life, but overestimated the hypoglycaemia-induced burden and anxiety. Counteractive behaviours were frequent: 23% of patients decreased their insulin dose, 20% increased their sugar intake and 12% ate extra snacks. Diabetologists were generally aware of these measures, but not of how often patients used them.
  
  
  CONCLUSIONS
  Diabetologists and patients do not share enough information about hypoglycaemia. Fear of hypoglycaemia and counteractive behaviours should be looked for by diabetologists. Systematic advice and specially adapted education should also be provided to increase patients' awareness of hypoglycaemia.
authors.affiliation: Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Brabois, CHU de Nancy, 54511 Vandoeuvre-les-Nancy, France. p.bohme@chu-nancy.fr
authors.forename: P
authors.initials: P
authors.lastname: Böhme
authors.forename: E
authors.initials: E
authors.lastname: Bertin
authors.forename: E
authors.initials: E
authors.lastname: Cosson
authors.forename: N
authors.initials: N
authors.lastname: Chevalier
mesh_terms: D001007:Anxiety / Q000209:etiology*; D003071:Cognition; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy; D004522:Educational Status; D004644:Emotions; D005260:Female; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology / Q000523:psychology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D010353:Patient Education as Topic; D010820:Physicians; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human