Rubin Nathan T, Seaquist Elizabeth R, Eberly Lynn, Kumar Anjali, Mangia Silvia, Öz Gülin, Moheet Amir
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
J Endocr Soc. 2022 Aug 1;6(9):bvac107. doi: 10.1210/jendso/bvac107. eCollection 2022 Sep 1.
Impaired awareness of hypoglycemia (IAH) is characterized by the diminished ability to perceive symptoms of hypoglycemia. Gold and Clark questionnaires are commonly used to identify patients with IAH. The relationship between IAH status on questionnaires and a person's symptom and epinephrine responses to hypoglycemia are not well understood.
We aimed to examine the relationship between hypoglycemia awareness status on Clarke and Gold questionnaires with both hormonal and symptomatic responses to experimental hypoglycemia.
In this university medical center study, we examined data from 78 subjects with type 1 diabetes (T1D) who completed both questionnaires and underwent a hyperinsulinemic hypoglycemic clamp (target glucose 50 mg/dL).
Clarke and Gold scores were highly correlated with one another (r = 0.82) and each had a moderate negative relationship with epinephrine (Clarke: r = -0.51, Gold: r = -0.50) and total symptom response (Clarke: r = -0.59, Gold: r = -0.57). However, 32% of the subjects were classified inconsistently by Clark vs Gold. A clustering analysis was done to examine how disagreement between the 2 questionnaires on IAH classification relates to epinephrine and symptoms responses during hypoglycemia. Subjects who had partial loss of symptoms or of epinephrine response were more likely to be classified inconsistently.
Our results show that IAH classification may be discordant between Clark and Gold questionnaires and that hypoglycemia awareness status on Clarke and Gold questionnaires poorly predicts hormonal and symptomatic responses to hypoglycemia in subjects with T1D and moderate blunting of symptoms or epinephrine.
低血糖意识受损（IAH）的特征是感知低血糖症状的能力下降。Gold问卷和Clark问卷常用于识别IAH患者。问卷上的IAH状态与个体对低血糖的症状及肾上腺素反应之间的关系尚未完全明确。
我们旨在研究Clark问卷和Gold问卷上的低血糖意识状态与实验性低血糖的激素及症状反应之间的关系。
在这项大学医学中心研究中，我们分析了78名1型糖尿病（T1D）患者的数据，这些患者完成了两份问卷并接受了高胰岛素低血糖钳夹试验（目标血糖50mg/dL）。
Clark评分和Gold评分高度相关（r = 0.82），且二者与肾上腺素（Clark：r = -0.51，Gold：r = -0.50）及总症状反应（Clark：r = -0.59，Gold：r = -0.57）均呈中度负相关。然而，32%的受试者在Clark问卷和Gold问卷上的分类不一致。进行聚类分析以研究两份问卷在IAH分类上的分歧与低血糖期间肾上腺素和症状反应之间的关系。症状或肾上腺素反应部分丧失的受试者更有可能被分类不一致。
我们的结果表明，Clark问卷和Gold问卷在IAH分类上可能存在不一致，且Clark问卷和Gold问卷上的低血糖意识状态对T1D且症状或肾上腺素反应中度减弱的受试者的低血糖激素及症状反应预测性较差。
