Background: Diabetes-related anxiety influences the quality-of-life of people with diabetes. Aim: To compare diabetes-related concerns in insulin-treated patients with type 1 and type 2 diabetes. Method: A cross-sectional questionnaire survey was carried out in two cohorts of adult outpatients with type 1 diabetes (n=223) and insulin-treated type 2 diabetes (n=104). Assessment of concerns about mild and severe hypoglycaemia, blindness and kidney failure was carried out using the seven-point Likert scale. Results: Insulin-treated patients with type 1 or 2 diabetes worry mostly about late diabetic complications, less about severe hypoglycaemia and little about mild hypoglycaemia. Patients with type 1 diabetes worry more about severe hypoglycaemia than those with type 2 diabetes; no differences in levels of anxiety about mild hypoglycaemia, blindness and kidney failure exist. Severe hypoglycaemia in the preceding year is associated with more worry about severe hypoglycaemia in patients with type 1 or 2 diabetes. Those with type 1 or 2 diabetes who have impaired awareness of hypoglycaemia tend to worry more about severe hypoglycaemia than those with normal awareness of hypoglycaemia. The presence of eye or kidney complications does not influence the level of anxiety in people with type 1 diabetes. Patients with type 2 diabetes without complications tend to worry more about mild and severe hypoglycaemia than those with complications. Conclusion: Patients with insulin-treated diabetes worry considerably about microvascular complications and severe hypoglycaemia risk. Recent experience of severe hypoglycaemia and presence of impaired hypoglycaemia awareness are associated with increased worry scores for severe hypoglycaemia in patients with type 1 or 2 diabetes. Screening for diabetes-related concerns should be integrated into diabetes care.

Aim: To compare self-treatment of mild symptomatic hypoglycaemia in people with type 1 diabetes with national Danish guidelines recommending 10-20 g of refined carbohydrate initially followed by unrefined carbohydrates. Methods: A cohort of 201 patients with type 1 diabetes filled in a questionnaire including self-treatment of mild symptomatic hypoglycaemia and occurrence of mild and severe hypoglycaemia. Initial intake of less than 10 g of refined carbohydrate was defined as under treatment and intake of 20 g or more as over treatment. Results: A total of 147 patients (73%) answered both questions about initial and follow-up self-treatment of hypoglycaemia. Fifty per cent of patients treated themselves with 10-20 g refined carbohydrates (female:male = 59%:43%; p<0.05), whereas 37% over treated (female:male = 34%:39%; not significant) and 13% under treated (female:male = 6%:18%; p<0.05). Initial treatment was followed by consumption of unrefined carbohydrates in 70% of the patients. Overall, 37% (female:male = 49%:28%; p<0.05) of the patients adhered to guidelines. The number of severe hypoglycaemic episodes (lifetime) and amount of carbohydrate intake were positively correlated (r=0.2; p<0.05). Adherence to guidelines was not related to occurrence of mild and severe (in the last year) hypoglycaemia, glycated haemoglobin, or fear of hypoglycaemia. Conclusions: Only about one-third of patients with type 1 diabetes treat mild hypoglycaemia according to guidelines. Female patients show better compliance. Patients with frequent episodes of severe hypoglycaemia over treat more often.

Background: Appropriate self-treatment of mild symptomatic hypoglycaemia is essential to prevent severe hypoglycaemia. Danish national guidelines recommend 10-20 g of refined carbohydrate (CH) initially, followed by a non-specified amount of unrefined CH. Aim: Our aim was to explore the effect of the amount of CH taken on glucose concentrations recorded by the MiniMed Continuous Glucose Monitoring System (CGMS) at mild symptomatic hypoglycaemic episodes. Method: A total of 125 adult patients with type 1 diabetes underwent 6 days of CGMS. HemoCue blood glucose determinations were used for calibration. All mild symptomatic episodes with a concomitant CGMS value ≤3.5 mmol/l were included in the analysis. Participants completed a detailed diary documenting all meals and snacks, insulin doses, and episodes and self-treatment of hypoglycaemia. CGMS values recorded 30 and 60 minutes after the episode were compared to CH intake. An initial intake of <10 g CH was defined as under treatment, and an intake of >20 g CH as over treatment. Treatment target was CGMS values of 3.6-10.0 mmol/l; values ≤3.5 mmol/l were defined as insufficient treatment, and values >10.0 mmol/l as overshooting the target. Results: A total of 126 mild symptomatic episodes was experienced in 52 (42%) of the patients. Initial carbohydrate intake could be calculated for 93 episodes. At 30 minutes, under treatment was associated with increased risk of insufficient response (57% versus 30%; p<0.01). At 60 minutes, over treatment was associated with increased risk of overshooting the target (23% versus 7%; p<0.05). An independent effect of follow-up intake of unrefined CH is not detectable within the first 60 minutes after treatment. Conclusion: Current guidelines for treatment of mild symptomatic hypoglycaemia are appropriate to ensure achievement of the glycaemic target.