Effects of continuous glucose monitor-recorded nocturnal hypoglycaemia on quality of life and mood during daily life in type 1 diabetes

Does nocturnal hypoglycaemia really improve quality of life? Reply to Søholm U, Broadley MM, Choudhary P et al [letter]

“…These studies include people with chronic diseases other than diabetes (chronic obstructive pulmonary disease, stroke, cancer) and even though the EQ-5D and the EQ-5D VAS has been used widely in diabetes [7], we acknowledge that the clinical importance of changes and differences in EQ-5D VAS in diabetes remains unclear and needs to be properly established. However, as the level of MID is approximately the same throughout the different studies [4][5][6], the MID in diabetes is likely to be in the same range, which supports the suggestion that the 10.3-point difference in EQ-5D VAS between days with or without preceding asymptomatic nocturnal hypoglycaemia observed in our study in participants with hypoglycaemia unawareness is clinically significant [2]. This is further supported by studies assessing the impact of complications of diabetes on EQ-5D VAS [8,9], which have shown that severe complications, such as blindness, amputation and cardiovascular disease, lead to similar differences in EQ-5D VAS of 3.6-11.2 points.…”

“…First, to address the question posed by Søholm and colleagues [1], 'Does nocturnal hypoglycaemia really improve quality of life? ', our data did not show a general effect of nocturnal hypoglycaemia in our cohort, but rather an effect of asymptomatic nocturnal hypoglycaemia only, which was limited to the subgroup of participants with selfreported severely impaired hypoglycaemia awareness (hypoglycaemia unawareness) [2]. The same individuals, who are prone to severe hypoglycaemia, reported lower mean scores on the EuroQol-5D visual analogue scale (EQ-5D VAS) as compared with those with normal awareness, as would be expected.…”

“…To the Editor: We thank Søholm et al [1] for their interest in our study comparing the effect of nocturnal hypoglycaemia on quality of life and mood in people with type 1 diabetes [2].…”

Relationship between CGM-derived nocturnal hypoglycemia and subjective sleep quality in people with type 1 diabetes

“…The heterogeneity of the impact of nocturnal hypoglycemia on sleep quality was evident from prior studies, with some showing that NH impacts sleep quality 6 , 7 , while others showing otherwise 8 – 10 . Our study reveals that at least part of this heterogeneity could be due to the heterogeneous nature of NH and its relationship to sleep quality as revealed by our study.…”

“…Some studies have shown that people with type 1 diabetes have a reduced threshold of awakening from NH and even increased sleep efficiency during NH 6 , 7 . A few other studies suggest that even asymptomatic hypoglycemia affects sleep quality 8 – 10 . While advances in diabetes technologies have reduced NH, they have had a variable impact on subjective sleep quality.…”