Diabetes Research Group, King's College London, London, UK.
Centre for Psychology at Universidade do Porto, Faculty of Psychology and Educational Sciences, Universidade do Porto, Porto, Portugal.
Diabetologia. 2023 Apr;66(4):631-641. doi: 10.1007/s00125-022-05847-7. Epub 2022 Dec 20.
AIMS/HYPOTHESIS: The aims of this study were to assess cognitions relating to hypoglycaemia in adults with type 1 diabetes and impaired awareness of hypoglycaemia before and after the multimodal HypoCOMPaSS intervention, and to determine cognitive predictors of incomplete response (one or more severe hypoglycaemic episodes over 24 months).
This analysis included 91 adults with type 1 diabetes and impaired awareness of hypoglycaemia who completed the Attitudes to Awareness of Hypoglycaemia (A2A) questionnaire before, 24 weeks and 24 months after the intervention, which comprised a short psycho-educational programme with optimisation of insulin therapy and glucose monitoring.
The age and diabetes duration of the participants were 48±12 and 29±12 years, respectively (mean±SD). At baseline, 91% reported one or more severe hypoglycaemic episodes over the preceding 12 months; this decreased to <20% at 24 weeks and after 24 months (p=0.001). The attitudinal barrier 'hyperglycaemia avoidance prioritised' (η=0.250, p=0.001) decreased from baseline to 24 weeks, and this decrease was maintained at 24 months (mean±SD=5.3±0.3 vs 4.3±0.3 vs 4.0±0.3). The decrease in 'asymptomatic hypoglycaemia normalised' from baseline (η=0.113, p=0.045) was significant at 24 weeks (1.5±0.3 vs 0.8±0.2). Predictors of incomplete hypoglycaemia response (one or more further episodes of severe hypoglycaemia) were higher baseline rates of severe hypoglycaemia, higher baseline scores for 'asymptomatic hypoglycaemia normalised', reduced change in 'asymptomatic hypoglycaemia normalised' scores at 24 weeks, and lower baseline 'hypoglycaemia concern minimised' scores (all p<0.05).
CONCLUSIONS/INTERPRETATION: Participation in the HypoCOMPaSS RCT was associated with improvements in hypoglycaemia-associated cognitions, with 'hyperglycaemia avoidance prioritised' most prevalent. Incomplete prevention of subsequent severe hypoglycaemia episodes was associated with persistence of the cognition 'asymptomatic hypoglycaemia normalised'. Understanding and addressing cognitive barriers to hypoglycaemia avoidance is important in individuals prone to severe hypoglycaemia episodes.
www.isrctn.org : ISRCTN52164803 and https://eudract.ema.europa.eu : EudraCT2009-015396-27.
目的/假设：本研究的目的是评估 1 型糖尿病和低血糖意识受损患者在接受多模式 HypoCOMPaSS 干预前后与低血糖相关的认知，并确定不完全反应（24 个月内发生一次或多次严重低血糖发作）的认知预测因素。
本分析包括 91 名 1 型糖尿病和低血糖意识受损的成年人，他们在干预前、24 周和 24 个月后完成了低血糖意识态度量表（A2A）问卷，该干预包括一个简短的心理教育计划，同时优化胰岛素治疗和血糖监测。
参与者的年龄和糖尿病病程分别为 48±12 岁和 29±12 岁（平均值±标准差）。基线时，91%的人报告在过去 12 个月内发生过一次或多次严重低血糖发作；这一比例在 24 周和 24 个月时降至<20%（p=0.001）。态度障碍“高血糖回避优先”（η=0.250，p=0.001）从基线到 24 周下降，这一下降在 24 个月时保持不变（平均值±标准差=5.3±0.3 对 4.3±0.3 对 4.0±0.3）。从基线开始，“无症状性低血糖正常化”（η=0.113，p=0.045）的下降在 24 周时具有显著意义（1.5±0.3 对 0.8±0.2）。不完全预防随后严重低血糖发作的预测因素是：严重低血糖发作的基线率较高，“无症状性低血糖正常化”的基线评分较高，24 周时“无症状性低血糖正常化”评分的变化减少，以及较低的基线“低血糖担忧最小化”评分（均 p<0.05）。
结论/解释：参与 HypoCOMPaSS RCT 与低血糖相关认知的改善有关，其中“高血糖回避优先”最为普遍。随后严重低血糖发作的不完全预防与“无症状性低血糖正常化”认知的持续存在有关。了解和解决低血糖回避的认知障碍对易发生严重低血糖发作的个体很重要。
www.isrctn.org：ISRCTN52164803 和 https://eudract.ema.europa.eu：EudraCT2009-015396-27。
