title: Severe hypoglycemia, impaired awareness of hypoglycemia, and self-monitoring in adults with type 1 diabetes: Results from Diabetes MILES-Australia.
abstract: OBJECTIVE
  To assess prevalence of severe hypoglycemia, awareness and symptoms of hypoglycemia, and their associations with self-monitoring of blood glucose.
  
  
  METHODS
  Diabetes MILES-Australia Study participants completed validated questionnaires and study-specific items.
  
  
  RESULTS
  Of 642 adults with type 1 diabetes, 21% reported ≥1 severe hypoglycemic event in the past six months, and 21% reported impaired awareness of hypoglycemia (IAH). Severe hypoglycemia was increased four-fold for those with IAH compared with intact awareness (1.4±3.9 versus 0.3±1.0). Of those with IAH, 92% perceived autonomic and 88% neuroglycopenic symptoms, albeit at lower glucose thresholds compared to people with intact awareness. Those with IAH were more likely to perceive both symptom types at the same glucose level or to perceive neuroglycopenic symptoms first (all p<0.001). Eighteen percent with IAH treated hypoglycemia only when they perceived symptoms and another 18% only when their capillary glucose was <3.0mmol/L.
  
  
  CONCLUSIONS
  One in five adults with type 1 diabetes had IAH or experienced severe hypoglycemia in the past sixmonths. Total loss of hypoglycemia symptoms was rare; most people with IAH retained autonomic symptoms, perceived at relatively low glucose levels. Frequent self-monitoring of blood glucose prompted early recognition and treatment of hypoglycemia, suggesting severe hypoglycemia risk can be minimized.
authors.affiliation: School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia. Electronic address: chendrieckx@acbrd.org.au.
authors.forename: Christel
authors.initials: C
authors.lastname: Hendrieckx
authors.affiliation: School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.
authors.forename: Virginia
authors.initials: V
authors.lastname: Hagger
authors.affiliation: University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Alicia
authors.initials: A
authors.lastname: Jenkins
authors.affiliation: School of Psychology and Clinical Sciences, Charles Darwin University, Casuarina, Northern Territory, Australia.
authors.forename: Timothy Chas
authors.initials: TC
authors.lastname: Skinner
authors.affiliation: Centre of Research on Psychology in Somatic diseases (CoRPS) & Department of Medical and Clinical Psychology, Tilburg University, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Pouwer
authors.affiliation: School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia; AHP Research, Hornchurch, Essex, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Speight
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D015190:Blood Glucose Self-Monitoring; D060825:Cognitive Dysfunction / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D059026:Diagnostic Self Evaluation; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D012306:Risk; D057566:Self Report; D000073278:Self-Management; D012720:Severity of Illness Index
keywords: Impaired awareness of hypoglycemia; Self-monitoring of blood glucose; Severe hypoglycemia; Symptom recognition; Type 1 diabetes