Centre for Psychology at University of Porto, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal.
Department of Diabetes, School of Life Course Sciences, King's College London, London, United Kingdom.
Diabetes Technol Ther. 2020 Jul;22(7):541-545. doi: 10.1089/dia.2020.0034.
Developing technologies in real-time continuous glucose monitoring (CGM) are successfully reducing severe hypoglycemia (SH) in trials and clinical practice. Their impact on impaired awareness of hypoglycemia, a major risk factor for SH, is uncertain. The present study examined two scales for assessing hypoglycemia awareness status, the Gold score and the eight-item Minimally Modified Clarke Hypoglycemia Survey (MMCHS), commonly used in trials of CGM, in Portuguese-speaking adults with type 1 diabetes and conducted an exploratory factor analysis on MMCHS. A bifactorial structure in MMCHS was revealed, with a clear distinction between items that measure SH experience and those that measure hypoglycemia awareness status. The latter is associated with the same risk for SH as the Gold score. We conclude that improvement in awareness scores by the MMCHS may reflect only a reduction in SH with no restoration of endogenous awareness, making the current literature consistent in evidence that CGM does not improve endogenous awareness and nonsensor supported protection from SH. This has implications for risk of SH when CGM is not being worn.
实时连续血糖监测 (CGM) 技术的发展在试验和临床实践中成功降低了严重低血糖 (SH) 的发生。但其对低血糖意识受损的影响，这是 SH 的一个主要危险因素，尚不确定。本研究使用两种评估低血糖意识状态的量表，即 Gold 评分和常用于 CGM 试验的八条目最小修正 Clarke 低血糖调查 (MMCHS)，对葡语母语的 1 型糖尿病成年人进行了评估，并对 MMCHS 进行了探索性因子分析。MMCHS 呈现出双因素结构，其中明确区分了衡量 SH 体验的项目和衡量低血糖意识状态的项目。后者与 Gold 评分一样，与 SH 的风险相关。我们得出结论，MMCHS 的意识评分的提高可能仅反映了 SH 的减少，而没有恢复内源性意识，这与 CGM 不能改善内源性意识和无传感器支持的 SH 保护的现有文献证据一致。这意味着在不佩戴 CGM 时，SH 的风险会增加。
