Department of Diabetes, Faculty of Life Sciences, King's College London, London, UK.
Department of Biostatistics & Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Diabetologia. 2022 Jun;65(6):936-948. doi: 10.1007/s00125-022-05679-5. Epub 2022 Mar 24.
AIMS/HYPOTHESIS: Problematic hypoglycaemia still complicates insulin therapy for some with type 1 diabetes. This study describes baseline emotional, cognitive and behavioural characteristics in participants in the HARPdoc trial, which evaluates a novel intervention for treatment-resistant problematic hypoglycaemia.
We documented a cross-sectional baseline description of 99 adults with type 1 diabetes and problematic hypoglycaemia despite structured education in flexible insulin therapy. The following measures were included: Hypoglycaemia Fear Survey II (HFS-II); Attitudes to Awareness of Hypoglycaemia questionnaire (A2A); Hospital Anxiety and Depression Index; and Problem Areas In Diabetes. k-mean cluster analysis was applied to HFS-II and A2A factors. Data were compared with a peer group without problematic hypoglycaemia, propensity-matched for age, sex and diabetes duration (n = 81).
The HARPdoc cohort had long-duration diabetes (mean ± SD 35.8 ± 15.4 years), mean ± SD Gold score 5.3 ± 1.2 and a median (IQR) of 5.0 (2.0-12.0) severe hypoglycaemia episodes in the previous year. Most individuals had been offered technology and 49.5% screened positive for anxiety (35.0% for depression and 31.3% for high diabetes distress). The cohort segregated into two clusters: in one (n = 68), people endorsed A2A cognitive barriers to hypoglycaemia avoidance, with low fear on HFS-II factors; in the other (n = 29), A2A factor scores were low and HFS-II high. Anxiety and depression scores were significantly lower in the comparator group.
CONCLUSIONS/INTERPRETATION: The HARPdoc protocol successfully recruited people with treatment-resistant problematic hypoglycaemia. The participants had high anxiety and depression. Most of the cohort endorsed unhelpful health beliefs around hypoglycaemia, with low fear of hypoglycaemia, a combination that may contribute to persistence of problematic hypoglycaemia and may be a target for adjunctive psychological therapies.
目的/假设：对于一些 1 型糖尿病患者来说，严重低血糖仍然使胰岛素治疗复杂化。本研究描述了 HARPdoc 试验参与者的基线情绪、认知和行为特征，该试验评估了一种针对治疗抵抗性严重低血糖的新干预措施。
我们记录了 99 例 1 型糖尿病且经结构化灵活胰岛素治疗后仍存在严重低血糖的成年人的横断面基线描述。纳入以下措施：低血糖恐惧调查 II （HFS-II）；低血糖意识态度问卷（A2A）；医院焦虑和抑郁量表；以及糖尿病问题区域。应用 k-均值聚类分析 HFS-II 和 A2A 因子。将数据与无严重低血糖的同龄、性别和糖尿病病程匹配的对照组（n=81）进行比较。
HARPdoc 队列的糖尿病病程较长（平均±标准差 35.8±15.4 年），平均±标准差 Gold 评分 5.3±1.2，前一年有中位数（IQR）5.0（2.0-12.0）次严重低血糖发作。大多数人都接受了技术治疗，49.5%的人焦虑筛查阳性（35.0%抑郁和 31.3%糖尿病困扰较高）。该队列分为两个亚组：一组（n=68）的人在避免低血糖方面存在 A2A 认知障碍，HFS-II 因子的恐惧程度较低；另一组（n=29）的 A2A 因子评分较低，HFS-II 评分较高。对照组的焦虑和抑郁评分明显较低。
结论/解释：HARPdoc 方案成功招募了治疗抵抗性严重低血糖患者。参与者有较高的焦虑和抑郁。该队列的大多数人对低血糖存在无益的健康信念，低血糖恐惧程度较低，这种组合可能导致严重低血糖持续存在，可能是辅助心理治疗的目标。
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