Department of Psychology, University of Southern Denmark, Odense, Denmark.
School of Psychology, Deakin University, Geelong, Victoria, Australia.
PLoS One. 2021 Dec 2;16(12):e0260896. doi: 10.1371/journal.pone.0260896. eCollection 2021.
To conduct a systematic review to examine associations between hypoglycemia and quality of life (QoL) in children and adolescents with type 1 diabetes.
Four databases (Medline, Cochrane Library, CINAHL, PsycINFO) were searched systematically in November 2019 and searches were updated in September 2021. Studies were eligible if they included children and/or adolescents with type 1 diabetes, reported on the association between hypoglycemia and QoL (or related outcomes), had a quantitative design, and were published in a peer-reviewed journal after 2000. A protocol was registered the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020154023). Studies were evaluated using the Joanna Briggs Institute's critical appraisal tool. A narrative synthesis was conducted by outcome and hypoglycemia severity.
In total, 27 studies met inclusion criteria. No hypoglycemia-specific measures of QoL were identified. Evidence for an association between SH and (domains) of generic and diabetes-specific QoL was too limited to draw conclusions, due to heterogenous definitions and operationalizations of hypoglycemia and outcomes across studies. SH was associated with greater worry about hypoglycemia, but was not clearly associated with diabetes distress, depression, anxiety, disordered eating or posttraumatic stress disorder. Although limited, some evidence suggests that more recent, more frequent, or more severe episodes of hypoglycemia may be associated with adverse outcomes and that the context in which hypoglycemia takes places might be important in relation to its impact.
There is insufficient evidence regarding the impact of hypoglycemia on QoL in children and adolescents with type 1 diabetes at this stage. There is a need for further research to examine this relationship, ideally using hypoglycemia-specific QoL measures.
系统回顾考察 1 型糖尿病儿童和青少年低血糖与生活质量（QoL）之间的关联。
2019 年 11 月系统检索了 4 个数据库（Medline、Cochrane 图书馆、CINAHL、PsycINFO），并于 2021 年 9 月进行了更新。如果研究纳入了 1 型糖尿病儿童和/或青少年，报告了低血糖与 QoL（或相关结局）之间的关联，采用定量设计，并且在 2000 年后发表在同行评议期刊上，则研究符合纳入标准。该研究方案已在国际前瞻性系统评价注册库（PROSPERO；CRD42020154023）中注册。研究采用 Joanna Briggs 研究所的批判性评估工具进行评估。根据结局和低血糖严重程度进行叙述性综合。
共有 27 项研究符合纳入标准。没有发现专门针对低血糖的 QoL 测量方法。由于研究之间低血糖的定义和操作化以及结局存在异质性，因此无法得出关于 SH 与通用和糖尿病特异性 QoL（各领域）之间关联的结论。SH 与对低血糖的担忧增加有关，但与糖尿病困扰、抑郁、焦虑、饮食障碍或创伤后应激障碍无明显关联。尽管证据有限，但一些证据表明，最近、更频繁或更严重的低血糖发作可能与不良结局有关，并且低血糖发生的背景与其影响有关。
在现阶段，关于 1 型糖尿病儿童和青少年低血糖对 QoL 的影响的证据不足。需要进一步研究来检验这种关系，理想情况下使用低血糖特异性 QoL 测量方法。
