Type 1 diabetes

Need to rebalance on severe hypoglycaemia: expert

Prof Jane Speight

People with type 1 diabetes continue to have unacceptably high rates of severe hypoglycaemia because there is too much emphasis on good glycaemic control and preventing long term complications over other important outcomes for patients, an Australian researcher says.

The legacy of trials such as DCCT means that hypoglycaemic events are still seen by patients as ‘a necessary evil’, according to Professor Jane Speight, Foundation Director of the Australian Centre for Behavioural Research in Diabetes at Deakin University, Victoria.

Speaking at ADC 2018 in Adelaide, Professor Speight said that despite all the advances in diabetes care the prevalence of severe hypoglycaemic events had remained unchanged over the last 30 years.

Australian figures showed that about one in five patients with T1D managed in specialist centres were affected by severe hypoglycaemic and other figures presented at ADC 2018 showed high rates of emergency department presentations in Victoria for severe hypoglcaemic events.

One of the main drivers of exposure to hypoglycaemia was the mindset of patients, encouraged by their health professionals, to focus absolutely on tight control of blood glucose, she said.

Psychological studies of patients with recurrent severe hypoglycaemia showed they had greater fears about hyperglycaemia and long term complications than they did about hypoglycaemia.

“I’d rather be in a hypo than blind” was a typical comment from a patient reflecting hyperglycaemia avoidance, Professor Speight said.

Findings from the HypoCompass study of  patients with T1D showed almost 60% had worries about high blood glucose, she noted. And one in four patients feared their doctor’s reactions to having high blood glucose.

Such anxiety led to compensatory behaviours such as using extra insulin and undertreating low blood glucose levels, said Professor Speight.

“Basically it’s about a person’s determination to be in that [tight] range,” she told the conference.

Professor Speight said that technology could be part of the solution to recurrent severe hypoglycaemia but it was expensive and not suitable for all patients. The preferred option should be structured education programs, backed by clinicians’ support, she suggested.

Talking about hypoglycaemia could be challenging because patients may be fearful of being blamed for doing something wrong or worried about losing their driving licence, she said.

But there was good advice available in resources such as “Diabetes and Emotional Health published by the NDSS, she said.

“Hypoglycaemic is not a necessary evil. It’s time for some balance and we need to make hypoglycaemia part of the conversation,” she concluded.

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