title: Impaired awareness of hypoglycaemia in subjects with type 1 diabetes. Results of an online survey in a diabetes web site.
abstract: OBJECTIVE
  To assess the frequency of impaired awareness of hypoglycaemia (IAH) using a specific questionnaire (Spanish version) in a free access diabetes-related web site.
  
  
  METHODS
  Data from a free access Spanish version of the Clarke test previously uploaded to the website of the Fundación para la Diabetes (March 2014-January 2015) were assessed. In addition to the eight questions in Clarke's questionnaire, information on type of diabetes, age, and disease duration was obtained. The Clarke test divided participants into three categories: normal awareness, uncertain and IAH.
  
  
  RESULTS
  Of the 418 participants with type 1 diabetes, 51.2% were aged 36-55 years. In 34.7%, diabetes had been diagnosed >15 years before, while disease duration was <2 years in 11%. According to Clarke categories, 23.4% had IAH, 15.3% uncertain awareness, and 61.3% normal awareness. The longer the duration of diabetes, the higher the Clarke test score. According to the Clarke test, 14.1% of participants had experienced at least one episode of severe hypoglycaemia in the previous year, and half of these (7.4%) had suffered severe hypoglycaemia two or more times. All but one of the participants with two or more episodes of severe hypoglycaemia had IAH.
  
  
  CONCLUSIONS
  Our study shows that the rate of IAH using an online survey is similar (25%) to that previously reported in other geographical areas, increases with diabetes duration, and identifies subjects prone to severe hypoglycaemia.
authors.affiliation: Diabetes Unit. Endocrinology and Nutrition, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Hospital Clínic i Universitari, Barcelona, Spain. Electronic address: iconget@clinic.ub.es.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Conget
authors.affiliation: Endocrinology and Nutrition Department, Health Services Center, University of León, León, Spain.
authors.forename: Dalia
authors.initials: D
authors.lastname: Ávila
authors.affiliation: Diabetes Unit. Endocrinology and Nutrition, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Hospital Clínic i Universitari, Barcelona, Spain.
authors.forename: Marga
authors.initials: M
authors.lastname: Giménez
authors.affiliation: Diabetes Unit. Endocrinology and Nutrition, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Hospital Clínic i Universitari, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Quiros
authors.affiliation: Fundación para la Diabetes, Madrid, Diabetes Unit, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Salaverria
authors.affiliation: Fundación para la Diabetes, Madrid, Diabetes Unit, Spain.
authors.forename: Belen
authors.initials: B
authors.lastname: Dueñas
mesh_terms: D000328:Adult; D001364:Awareness; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
keywords: Diabetes mellitus tipo 1; Hipoglucemia; Hipoglucemia desapercibida; Hypoglycaemia; Hypoglycaemia unawareness; Type 1 diabetes mellitus