CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
Nutr Metab Cardiovasc Dis. 2019 Jul;29(7):736-743. doi: 10.1016/j.numecd.2019.04.009. Epub 2019 May 6.
Hypoglycemia represents a relevant burden in people with diabetes. Consequences of hypoglycemia/fear of hypoglycemia on quality of life (QoL) and behaviors of patients with T1DM and T2DM were assessed.
HYPOS-1 was an observational retrospective study. Fear of hypoglycemia (Fear of Hypoglycemia Questionnaire, FHQ), general health status (visual analog scale of EuroQol questionnaire, EQ5D-VAS) psychological well-being (WHO-5 well being index, WHO-5), diabetes related distress (Problem Areas in Diabetes 5, PAID-5), and corrective/preventive behaviors following hypoglycemia were compared between people with and without previous experience of severe and symptomatic hypoglycemia and by tertiles of FHQ scores. A multivariate analysis was performed to identify factors associated with the likelihood of being in the third tertile of FHQ score. Overall, 2229 patients were involved. Severe hypoglycemia had statistically significant and clinically relevant (measured as effect sizes) negative impact on EQ5D-VAS, WHO-5, PAID-5, and FHQ both in T1DM and T2DM. In T2DM, symptomatic episodes had similar impact of severe hypoglycemia. Moving from the first to the third FHQ tertile, lower scores of EQ-5D VAS and WHO-5, and higher levels of PAID-5 were found. Patients in the third tertile performed more frequently corrective/preventive actions that negatively impact on metabolic control. Previous hypoglycemia, insulin treatment, female gender, age, and school education were the independent factors associated with increased likelihood to be in the third tertile.
Not only severe but also symptomatic hypoglycemia negatively affect patient QoL, especially in T2DM. Addressing fear of hypoglycemia should be a goal of diabetes education.
低血糖在糖尿病患者中是一个重要的负担。评估了 1 型糖尿病和 2 型糖尿病患者的低血糖/对低血糖的恐惧对生活质量（QoL）和行为的影响。
HYPOS-1 是一项观察性回顾性研究。使用低血糖恐惧问卷（Fear of Hypoglycemia Questionnaire，FHQ）、欧洲五维健康量表（EuroQol questionnaire，EQ5D-VAS）的一般健康状况、心理健康（WHO-5 幸福感指数，WHO-5）、糖尿病相关困扰（Problem Areas in Diabetes 5，PAID-5）以及低血糖后的纠正/预防行为，比较了有和无严重和有症状低血糖史的患者之间以及 FHQ 评分三分位数之间的差异。进行了多变量分析，以确定与 FHQ 评分第三分位数相关的因素。共有 2229 名患者参与了研究。在 1 型糖尿病和 2 型糖尿病中，严重低血糖对 EQ5D-VAS、WHO-5、PAID-5 和 FHQ 均有统计学显著和临床相关（以效应大小衡量）的负面影响。在 2 型糖尿病中，症状性发作对严重低血糖的影响与严重低血糖相似。从 FHQ 的第一分到第三分，发现 EQ-5D VAS 和 WHO-5 的评分降低，PAID-5 的评分升高。处于第三分位的患者更频繁地采取纠正/预防措施，但这些措施会对代谢控制产生负面影响。既往低血糖、胰岛素治疗、女性、年龄和学校教育是与处于第三分位的可能性增加相关的独立因素。
不仅严重低血糖，而且有症状的低血糖也会对患者的 QoL 产生负面影响，尤其是在 2 型糖尿病中。解决对低血糖的恐惧应该是糖尿病教育的目标。
