title: Cognitive, behavioural and psychological barriers to the prevention of severe hypoglycaemia: A qualitative study of adults with type 1 diabetes.
abstract: OBJECTIVE
  Severe hypoglycaemia affects approximately one in three people with type 1 diabetes and is the most serious side effect of insulin therapy. Our aim was to explore individualistic drivers of severe hypoglycaemia events.
  
  
  METHODS
  In-depth semi-structured interviews were conducted with a purposive sample of 17 adults with type 1 diabetes and a history of recurrent severe hypoglycaemia, to elicit experiences of hypoglycaemia (symptoms/awareness, progression from mild to severe and strategies for prevention/treatment). Interviews were analysed using an adapted grounded theory approach.
  
  
  RESULTS
  Three main themes emerged: hypoglycaemia-induced cognitive impairment, behavioural factors and psychological factors. Despite experiencing early hypoglycaemic symptoms, individuals often delayed intervention due to impaired/distracted attention, inaccurate risk assessment, embarrassment, worry about rebound hyperglycaemia or unavailability of preferred glucose source. Delay coupled with use of a slow-acting glucose source compromised prevention of severe hypoglycaemia.
  
  
  CONCLUSIONS
  Our qualitative data highlight the multifaceted, idiosyncratic nature of severe hypoglycaemia and confirm that individuals with a history of recurrent severe hypoglycaemia may have specific thought and behaviour risk profiles. Individualised prevention plans are required, emphasising both the need to attend actively to mild hypoglycaemic symptoms and to intervene promptly with an appropriate, patient-preferred glucose source to prevent progression to severe hypoglycaemia.
authors.affiliation: AHP Research, Hornchurch, UK; The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia - Vic, Melbourne, VIC, Australia; Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Speight
authors.affiliation: AHP Research, Hornchurch, UK.
authors.forename: Shalleen M
authors.initials: SM
authors.lastname: Barendse
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, Division of Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Harsimran
authors.initials: H
authors.lastname: Singh
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Little
authors.affiliation: Manchester Diabetes Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Endocrinology and Diabetes Research Group, Institute of Human Development, University of Manchester, Manchester, UK.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Rutter
authors.affiliation: Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, UK.
authors.forename: Simon R
authors.initials: SR
authors.lastname: Heller
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: James Am
authors.initials: JA
authors.lastname: Shaw
keywords: Severe hypoglycaemia; experience; prevention; qualitative; type 1 diabetes