title: History of mild hypoglycaemia does not affect the prevalence of diabetes-related distress in people with diabetes.
abstract: OBJECTIVE
  The occurrence of hypoglycaemia is assumed to be associated with increased diabetes-related distress. We investigated the association of mild hypoglycaemia (MH) with diabetes-related distress in a large outpatient cohort with diabetes type 1 (DM1) and type 2 (DM2).
  
  
  METHODS
  In a cross-sectional study, we recorded MH and simultaneously assessed diabetes-related distress with the PAID questionnaire in 783 people with diabetes [female 43.8 %, age 63.7 years, duration of diabetes 17.3 years, HbA1c 7.0 % (53 mmol/mol)] in an university outpatient department for metabolic diseases over a period of three months. Participants with and without MH were compared.
  
  
  RESULTS
  People with DM1 (n = 191) had 1.09 MH per week. Diabetes-related distress was not different comparing people with DM1 with (n = 125) and without (n = 66) MH (PAID score 18.4 ± 16.2 vs. 16.6 ± 15.0, p = 0.449). The frequency of MH per week in people with DM2 on oral antidiabetic therapy (n = 182) and with insulin therapy (n = 410) is low (0.03 vs. 0.1 episodes). People with DM2 on insulin therapy with (n = 72) and without (n = 338) MH have a comparable PAID score (17.9 ± 13.3 vs. 16.8 ± 14.9, p = 0.552). 14.4 % of those with DM1 as well as 12.5 % of those with DM2 on insulin feel hypoglycaemic events to be a "somewhat serious problem" or "serious problem".
  
  
  CONCLUSIONS
  In an outpatient setting, MH is not associated with increased diabetes-related distress or burden in people with DM1 or DM2.
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstrasse 18, 07743, Jena, Germany. nadine.kuniss@med.uni-jena.de.
authors.forename: Nadine
authors.initials: N
authors.lastname: Kuniss
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstrasse 18, 07743, Jena, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Kramer
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstrasse 18, 07743, Jena, Germany.
authors.forename: Nicolle
authors.initials: N
authors.lastname: Müller
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstrasse 18, 07743, Jena, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kloos
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstrasse 18, 07743, Jena, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: Wolf
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Bachstrasse 18, 07743, Jena, Germany.
authors.forename: Ulrich Alfons
authors.initials: UA
authors.lastname: Müller
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Diabetes-related distress; Mild hypoglycaemia; PAID questionnaire