Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

Yu Kuei Lin; Caroline R. Richardson; Iulia Dobrin; Melissa J. Dejonckheere; Kara Mizokami-Stout; Michael D. Fetters; James E. Aikens; Simon J. Fisher; Wen Ye; Rodica Pop-Busui

doi:10.2337/dc21-1285

Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

Yu Kuei Lin, Caroline R. Richardson, Iulia Dobrin, Melissa J. Dejonckheere, Kara Mizokami-Stout, Michael D. Fetters, James E. Aikens, Simon J. Fisher, Wen Ye, Rodica Pop-Busui

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

OBJECTIVE This study aimed to 1) identify the frequency of severe and level 2 hypoglycemia presenting in individuals with type 1 diabetes using continuous glucose monitoring systems (CGMs), including those with concomitant closed-loop insulin pumps, in a clinical practice setting and 2) evaluate the impact of beliefs around hypoglycemia in the development of severe and level 2 hypoglycemia in this population. RESEARCH DESIGN AND METHODS A cross-sectional survey study in adults with type 1 diabetes using CGMs >6 months was conducted at a large tertiary academic center. Participant demo-graphics, 6-month severe hypoglycemia history, hypoglycemia beliefs (with the Attitude to Awareness of Hypoglycemia questionnaire), and 4-week CGM glucose data were collected. Statistical analysis was performed to assess the presentation of severe and level 2 hypoglycemia and identify associated risk factors. RESULTS A total of 289 participants were recruited (including 257 participants with CGM data within the last 3 months). Of these, 25.6% experienced at least one severe hypoglycemic episode in the last 6 months, and 13.6% presented with ‡1% of time in level 2 hypoglycemia on CGMs. Reporting beliefs about prioritizing hyper-glycemia avoidance was associated with severe hypoglycemia development (P < 0.001), while having beliefs of minimal concerns for hypoglycemia was associated with spending ‡1% of time in level 2 hypoglycemia (P = 0.038). CONCLUSIONS Despite the use of advanced diabetes technologies, severe and level 2 hypoglycemia continues to occur in individuals with type 1 diabetes and high hypoglycemia risks. Human factors, including beliefs around hypoglycemia, may continue to impact the effectiveness of glucose self-management.

Original language	English
Pages (from-to)	520-528
Number of pages	9
Journal	Diabetes Care
Volume	45
Issue number	3
DOIs	https://doi.org/10.2337/dc21-1285
State	Published - Mar 2022

Bibliographical note

Funding Information:
Acknowledgments. The authors appreciate all the assistance from the faculties, the University of Michigan Adult Diabetes Education Program and Data Office for Clinical and Translational Research, and the Michigan Institute for Clinical and Health Research. The authors also thank all the study participants, without whom this study would not have been possible. Funding. This study was supported by Michigan Center for Clinical and Translational Research Pilot and Feasibility Grant P30DK092926. Y.K.L. was supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant K23DK129724. S.J.F. was supported by NIDDK grant R01DK118082. REDCap was supported by National Center for Advancing Translational Sciences grant UL1TR00240. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. Y.K.L., C.R.R., and R.P.-B. designed the study. Y.K.L. and I.D. recruited participants and collected data. Y.K.L., M.J.D., K.M.-S., M.D.F., J.E.A, S.J.F., and W.Y. analyzed and interpreted data. Y.K.L. wrote the first manuscript draft. All authors reviewed and contributed to the final draft of the manuscript. Y.K.L. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Publisher Copyright:
© 2022 by the American Diabetes Association.

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Advanced and Specialized Nursing

UN SDGs

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10.2337/dc21-1285

Cite this

Lin, Y. K., Richardson, C. R., Dobrin, I., Dejonckheere, M. J., Mizokami-Stout, K., Fetters, M. D., Aikens, J. E., Fisher, S. J., Ye, W., & Pop-Busui, R. (2022). Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies. Diabetes Care, 45(3), 520-528. https://doi.org/10.2337/dc21-1285

@article{3e456afa451b46758bb714f13d6f590c,

title = "Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies",

abstract = "OBJECTIVE This study aimed to 1) identify the frequency of severe and level 2 hypoglycemia presenting in individuals with type 1 diabetes using continuous glucose monitoring systems (CGMs), including those with concomitant closed-loop insulin pumps, in a clinical practice setting and 2) evaluate the impact of beliefs around hypoglycemia in the development of severe and level 2 hypoglycemia in this population. RESEARCH DESIGN AND METHODS A cross-sectional survey study in adults with type 1 diabetes using CGMs >6 months was conducted at a large tertiary academic center. Participant demo-graphics, 6-month severe hypoglycemia history, hypoglycemia beliefs (with the Attitude to Awareness of Hypoglycemia questionnaire), and 4-week CGM glucose data were collected. Statistical analysis was performed to assess the presentation of severe and level 2 hypoglycemia and identify associated risk factors. RESULTS A total of 289 participants were recruited (including 257 participants with CGM data within the last 3 months). Of these, 25.6% experienced at least one severe hypoglycemic episode in the last 6 months, and 13.6% presented with ‡1% of time in level 2 hypoglycemia on CGMs. Reporting beliefs about prioritizing hyper-glycemia avoidance was associated with severe hypoglycemia development (P < 0.001), while having beliefs of minimal concerns for hypoglycemia was associated with spending ‡1% of time in level 2 hypoglycemia (P = 0.038). CONCLUSIONS Despite the use of advanced diabetes technologies, severe and level 2 hypoglycemia continues to occur in individuals with type 1 diabetes and high hypoglycemia risks. Human factors, including beliefs around hypoglycemia, may continue to impact the effectiveness of glucose self-management.",

author = "Lin, {Yu Kuei} and Richardson, {Caroline R.} and Iulia Dobrin and Dejonckheere, {Melissa J.} and Kara Mizokami-Stout and Fetters, {Michael D.} and Aikens, {James E.} and Fisher, {Simon J.} and Wen Ye and Rodica Pop-Busui",

note = "Funding Information: Acknowledgments. The authors appreciate all the assistance from the faculties, the University of Michigan Adult Diabetes Education Program and Data Office for Clinical and Translational Research, and the Michigan Institute for Clinical and Health Research. The authors also thank all the study participants, without whom this study would not have been possible. Funding. This study was supported by Michigan Center for Clinical and Translational Research Pilot and Feasibility Grant P30DK092926. Y.K.L. was supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant K23DK129724. S.J.F. was supported by NIDDK grant R01DK118082. REDCap was supported by National Center for Advancing Translational Sciences grant UL1TR00240. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. Y.K.L., C.R.R., and R.P.-B. designed the study. Y.K.L. and I.D. recruited participants and collected data. Y.K.L., M.J.D., K.M.-S., M.D.F., J.E.A, S.J.F., and W.Y. analyzed and interpreted data. Y.K.L. wrote the first manuscript draft. All authors reviewed and contributed to the final draft of the manuscript. Y.K.L. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Publisher Copyright: {\textcopyright} 2022 by the American Diabetes Association.",

year = "2022",

month = mar,

doi = "10.2337/dc21-1285",

language = "English",

volume = "45",

pages = "520--528",

number = "3",

}

Lin, YK, Richardson, CR, Dobrin, I, Dejonckheere, MJ, Mizokami-Stout, K, Fetters, MD, Aikens, JE, Fisher, SJ, Ye, W & Pop-Busui, R 2022, 'Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies', Diabetes Care, vol. 45, no. 3, pp. 520-528. https://doi.org/10.2337/dc21-1285

Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies. / Lin, Yu Kuei; Richardson, Caroline R.; Dobrin, Iulia et al.
In: Diabetes Care, Vol. 45, No. 3, 03.2022, p. 520-528.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

AU - Lin, Yu Kuei

AU - Richardson, Caroline R.

AU - Dobrin, Iulia

AU - Dejonckheere, Melissa J.

AU - Mizokami-Stout, Kara

AU - Fetters, Michael D.

AU - Aikens, James E.

AU - Fisher, Simon J.

AU - Ye, Wen

AU - Pop-Busui, Rodica

N1 - Funding Information: Acknowledgments. The authors appreciate all the assistance from the faculties, the University of Michigan Adult Diabetes Education Program and Data Office for Clinical and Translational Research, and the Michigan Institute for Clinical and Health Research. The authors also thank all the study participants, without whom this study would not have been possible. Funding. This study was supported by Michigan Center for Clinical and Translational Research Pilot and Feasibility Grant P30DK092926. Y.K.L. was supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant K23DK129724. S.J.F. was supported by NIDDK grant R01DK118082. REDCap was supported by National Center for Advancing Translational Sciences grant UL1TR00240. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. Y.K.L., C.R.R., and R.P.-B. designed the study. Y.K.L. and I.D. recruited participants and collected data. Y.K.L., M.J.D., K.M.-S., M.D.F., J.E.A, S.J.F., and W.Y. analyzed and interpreted data. Y.K.L. wrote the first manuscript draft. All authors reviewed and contributed to the final draft of the manuscript. Y.K.L. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Publisher Copyright: © 2022 by the American Diabetes Association.

PY - 2022/3

Y1 - 2022/3

N2 - OBJECTIVE This study aimed to 1) identify the frequency of severe and level 2 hypoglycemia presenting in individuals with type 1 diabetes using continuous glucose monitoring systems (CGMs), including those with concomitant closed-loop insulin pumps, in a clinical practice setting and 2) evaluate the impact of beliefs around hypoglycemia in the development of severe and level 2 hypoglycemia in this population. RESEARCH DESIGN AND METHODS A cross-sectional survey study in adults with type 1 diabetes using CGMs >6 months was conducted at a large tertiary academic center. Participant demo-graphics, 6-month severe hypoglycemia history, hypoglycemia beliefs (with the Attitude to Awareness of Hypoglycemia questionnaire), and 4-week CGM glucose data were collected. Statistical analysis was performed to assess the presentation of severe and level 2 hypoglycemia and identify associated risk factors. RESULTS A total of 289 participants were recruited (including 257 participants with CGM data within the last 3 months). Of these, 25.6% experienced at least one severe hypoglycemic episode in the last 6 months, and 13.6% presented with ‡1% of time in level 2 hypoglycemia on CGMs. Reporting beliefs about prioritizing hyper-glycemia avoidance was associated with severe hypoglycemia development (P < 0.001), while having beliefs of minimal concerns for hypoglycemia was associated with spending ‡1% of time in level 2 hypoglycemia (P = 0.038). CONCLUSIONS Despite the use of advanced diabetes technologies, severe and level 2 hypoglycemia continues to occur in individuals with type 1 diabetes and high hypoglycemia risks. Human factors, including beliefs around hypoglycemia, may continue to impact the effectiveness of glucose self-management.

AB - OBJECTIVE This study aimed to 1) identify the frequency of severe and level 2 hypoglycemia presenting in individuals with type 1 diabetes using continuous glucose monitoring systems (CGMs), including those with concomitant closed-loop insulin pumps, in a clinical practice setting and 2) evaluate the impact of beliefs around hypoglycemia in the development of severe and level 2 hypoglycemia in this population. RESEARCH DESIGN AND METHODS A cross-sectional survey study in adults with type 1 diabetes using CGMs >6 months was conducted at a large tertiary academic center. Participant demo-graphics, 6-month severe hypoglycemia history, hypoglycemia beliefs (with the Attitude to Awareness of Hypoglycemia questionnaire), and 4-week CGM glucose data were collected. Statistical analysis was performed to assess the presentation of severe and level 2 hypoglycemia and identify associated risk factors. RESULTS A total of 289 participants were recruited (including 257 participants with CGM data within the last 3 months). Of these, 25.6% experienced at least one severe hypoglycemic episode in the last 6 months, and 13.6% presented with ‡1% of time in level 2 hypoglycemia on CGMs. Reporting beliefs about prioritizing hyper-glycemia avoidance was associated with severe hypoglycemia development (P < 0.001), while having beliefs of minimal concerns for hypoglycemia was associated with spending ‡1% of time in level 2 hypoglycemia (P = 0.038). CONCLUSIONS Despite the use of advanced diabetes technologies, severe and level 2 hypoglycemia continues to occur in individuals with type 1 diabetes and high hypoglycemia risks. Human factors, including beliefs around hypoglycemia, may continue to impact the effectiveness of glucose self-management.

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JO - Diabetes Care

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Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

Abstract

Bibliographical note

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UN SDGs

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