Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit
- Charlotte B Smith, BSc, MB,BS. (charlotte.b.smith{at}doctors.org.uk),
- Pratik Choudhary, MB,BS, MRCP,
- Andrew Pernet, RGN,
- David Hopkins, MB, BS, FRCP and
- Stephanie A Amiel, BSc, MD, FRCP
Abstract
Objective: Hypoglycemia unawareness (HU) increases severe hypoglycemia (SH) risk. Hypoglycemia avoidance restores awareness, but is difficult to sustain. We compared adherence to treatment changes by awareness status.
Research design and methods: Case notes of 90 Type 1 diabetic patients were analyzed retrospectively, identifying awareness status and insulin regimens over 4 visits. Proportion of patients adhering to advice and percent advice taken were calculated.
Results: 31 HA and 19 HU patients were identified with insulin regimens available in 23 and 13 respectively. HU patients were older (p=0.001); had longer diabetes duration (p=0.002) and lower HbA1c (p=0.007). More HU reported SH (p=0.002); fewer were adherent (53.8% vs 87.0%, p=0.046), with lower adherence scores (42.5±24.7 vs 75.3±27.5%, p=0.001).
Conclusions: Reduced adherence to changes in insulin regimen in HU is compatible with habituation to hypoglycemic stress. Therapies aimed at reversing repetitive harmful behaviors may be useful to restore HA and protection from SH.
Footnotes
-
- Received December 21, 2008.
- Accepted April 13, 2009.
- Copyright © American Diabetes Association
