Patient experience of hypoglycaemia unawareness in Type 1 diabetes: are patients appropriately concerned?

Abstract

A qualitative analysis of patient interviews identified deficits in education, technology and motivation in hypoglycaemia unawareness. Interventions can therefore be tailored to target underlying problems that prevent individual patients from regaining awareness. A brief assessment tool was devised to categorize patients' hypoglycaemia unawareness accordingly. Psychological interventions should be developed to address the problems of 'low concern' regarding hypoglycaemia unawareness.

Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes

“…As well as highlighting some of the unhelpful psychological attitudes described by Rogers et al 120 in their earlier qualitative study with patients with hypoglycaemia unawareness, patients in the current study talked in-depth about the various ways in which hypoglycaemia unawareness had had a detrimental impact on their lives. 141 In some cases this included having to give up work after experiencing severe hypoglycaemic episodes that had endangered their own safety and/or the safety of others in the workplace.…”

“…There is some evidence in the literature that people with this problem may be less perturbed by their condition, 120 and certainly less able to reverse it, 119 than the health-care professionals supporting them. Mühlhauser et al 144 first described this in relation to severe hypoglycaemia risk in a seminal prospective study of hypoglycaemia.…”

“…The topic guides were devised to take account of previous research that has identified patients' concerns about hypoglycaemia unawareness 120 and findings from the psychosocial research reported in Chapter 3 71,78,79 and had input from the research team and other DAFNE educators; they were also revised in light of ongoing data analysis in line with the principles of grounded theory research. 103 Sampling was also revised in light of early data analysis, in this instance through the inclusion of family members within the qualitative substudy.…”

“…119 Semistructured interviews with people with hypoglycaemia unawareness found that most had unhelpful attitudes and cognitions that were likely to inhibit hypoglycaemia avoidance. 120 The group were planning an intervention to explicitly tackle motivation to change behaviour with the intention of reducing hypoglycaemia and improving awareness. It was decided to devise and pilot an intervention to improve outcomes for people experiencing persistent problematic hypoglycaemia after conventional DAFNE training.…”

Experiences, Views, and Support Needs of Family Members of People With Hypoglycemia Unawareness: Interview Study

“…Such treatment barriers have been observed in an interview study with adults with type 1 diabetes affected by HU (7). Despite experiencing frightening, disabling, socially embarrassing, and dangerous episodes of severe hypoglycemia, more than half of those interviewed expressed a lack of concern and poor motivation to adopt hypoglycemia avoidance strategies.…”