scholarly journals Self-reported hypoglycaemia in patients treated with insulin: A large Slovenian retrospectively-prospective study

2017 ◽  
Vol 56 (4) ◽  
pp. 244-250
Author(s):  
Draženka Pongrac Barlovič ◽  
Andrej Zavratnik ◽  
Aleš Skvarča ◽  
Karmen Janša ◽  
Bojana Vukelič ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycated Haemoglobin ◽  
Daily Basis ◽  
Hypoglycaemic Event ◽  
Major Barrier ◽  
Time Period ◽  
Randomised Control Trials ◽  
Comprehensive Study

Abstract Introduction Hypoglycaemia is the major barrier for glycaemic target achievement in patients treated with insulin. The aim of the present study was to investigate real-world incidence and predictors of hypoglycaemia in insulin-treated patients. Methods More than 300 consecutive patients with type 1 or type 2 diabetes treated with insulin were enrolled during regular out-patient visits from 36 diabetes practices throughout the whole country. They completed a comprehensive questionnaire on hypoglycaemia knowledge, awareness, and incidence in the last month and last six months. In addition, in the prospective part, patients recorded incidence of hypoglycaemic events using a special diary prospectively on a daily basis, through 4 weeks. Results At least one hypoglycaemic event was self-reported in 84.1%, and 56.4% of patients with type 1 and type 2 diabetes, respectively, during the prospective period of 4 weeks. 43.4% and 26.2% of patients with type 1 and type 2 diabetes, respectively, experienced a nocturnal hypoglycaemic event. In the same time-period, severe hypoglycaemia was experienced by 15.9% and 7.1% of patients with type 1 and type 2 diabetes, respectively. Lower glycated haemoglobin was not a significant predictor of hypoglycaemia. Conclusions Rates of self-reported hypoglycaemia in patients treated with insulin in the largest and most comprehensive study in Slovenia so far are higher than reported from randomised control trials, but comparable to data from observational studies. Hypoglycaemia incidence was high even with high glycated haemoglobin values.

Conversations and Reactions Around Severe Hypoglycaemia (CRASH): Results from the German Cohort of a Global Survey of People with Type 1 Diabetes or Insulin-Treated Type 2 Diabetes and Caregivers

2020 ◽  
Author(s):  
Elisabeth Mönnig ◽  
Erik Spaepen ◽  
Beatrice Osumili ◽  
Beth D. Mitchell ◽  
Frank Snoek ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Severe Hypoglycaemia ◽  
Insulin Regimen ◽  
Hypoglycaemic Event ◽  
Cross Sectional Survey

Abstract Background A global cross-sectional survey (CRASH) was designed to provide information about the experiences of people with diabetes (PWD) and their caregivers in relation to severe hypoglycaemic events. Methods Adults with type 1 diabetes or insulin-treated type 2 diabetes who had experienced one or more severe hypoglycaemic events within the past 3 years, and adult caregivers for such people, were recruited from medical research panels using purposive sampling. We present here results from Germany. Results Approximately 100 individuals in each of the four participant groups completed a 30-minute online survey. Survey results indicated that the most recent severe hypoglycaemic event made many participants feel scared (80.4%), unprepared (70.4%), and/or helpless (66.5%). Severe hypoglycaemia was discussed by healthcare professionals at every visit with only 20.2% of participants who had ever had this conversation, and 53.5% of participants indicated that their insulin regimen had not changed following their most recent event. 37.1% of PWD/people with diabetes cared for by caregivers owned a glucagon kit at the time of survey completion. Conclusions The survey identified areas for improvement in the prevention and management of severe hypoglycaemic events. For healthcare professionals, these include enquiring more frequently about severe hypoglycaemia and adjusting blood glucose-lowering medication after a severe hypoglycaemic event. For individuals with diabetes and their caregivers, potential improvements include ensuring availability of glucagon at all times. Changes in these areas could lead not only to improved patient wellbeing but also to reduced use of emergency services/hospitalisation and, consequently, lower healthcare costs.

scholarly journals Coping strategies in Type 1 and Type 2 diabetes patients using insulin: the relationship with emotional well-being and glycaemic control

2015 ◽  
Vol 18 (4) ◽  
pp. 41-47
Author(s):  
Oleg G. Motovilin ◽  
Shishkova Y. Andreevna ◽  
Elena V. Surkova
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Coping Strategies ◽  
Depression Scale ◽  
Well Being ◽  
Glycated Haemoglobin ◽  
Epidemiologic Studies ◽  
Hba1c Levels

Background. Over the long disease course of diabetes mellitus (DM), with its demands in terms of everyday self-management of the disease, individual psychological characteristics may be associated with both emotional well-being (WB) and glycaemic control. The former includes various types of coping strategies (CSs) of the patients, which comprise the common ways for patients to overcome difficult situations.Aim. To study the relationships between CS and both glycaemic control and emotional WB in patients with Type 1 diabetes (T1D) and Type 2 diabetes (T2D) treated with insulin.Materials and methods. The study included 84 patients with T1D and 56 patients with insulin-treated T2D [age, 22.5 ± 3.3 and 61.0 ± 8.9 years; men/women, 29/55 and 11/45; duration of DM, 11.9 ± 5.36 and 11.6 ± 6.2 years and glycated haemoglobin (HbA1c), 9.1% ± 2.2% and 9.0% ± 1.4%, respectively]. The HbA1c levels were determined in all patients. The Strategic Approach to Coping Scale constructed by S. Hobfoll was used to study CS, and emotional WB was assessed based on the severity of anxiety and depression. Further, we used the State-Trait Anxiety Inventory developed by C.D. Spielberger and adapted by Y.L. Khanin and the Center for Epidemiologic Studies Depression Scale. Only Russian validated versions of the questionnaires were used in the study.Results. In both groups of patients, ‘Assertive (Persistent) Actions’ was positively associated with emotional WB. In patients with T2D, WB increases when using ‘Cautious Action’ and ‘Social Joining’. The deterioration of emotional WB was associated with ‘Aggressive Actions’ in both groups of patients. In patients with T1D, negative WB was also associated with ‘Avoidance’, while in patients with T2D, negative WB was associated with ‘Instinctive Actions’. In patients with T1D, ‘Instinctive Action’ was associated with higher HbA1c levels. In patients with T2D, ‘Cautious Action’, ‘Avoidance’ and ‘Antisocial Action’ were associated with lower HbA1c levels.Conclusion. In patients with T1D and T2D, CSs are associated with both emotional WB and glycaemic control. Emotional WB and lower HbA1c levels are associated with ‘Assertive Action’, ‘Cautious Action’, ‘Avoidance’ and ‘Asocial Action’. Negative WB and higher HbA1c levels are associated with ‘Aggressive Action’ and ‘Instinctive Action’.

scholarly journals Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review

2020 ◽  
Vol 24 (28) ◽  
pp. 1-232
Author(s):  
Kirsty Winkley ◽  
Rebecca Upsher ◽  
Daniel Stahl ◽  
Daniel Pollard ◽  
Architaa Kasera ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Meta Analysis ◽  
Glycated Haemoglobin ◽  
Behavioural Therapy

Background For people with diabetes mellitus to achieve optimal glycaemic control, motivation to perform self-management is important. The research team wanted to determine whether or not psychological interventions are clinically effective and cost-effective in increasing self-management and improving glycaemic control. Objectives The first objective was to determine the clinical effectiveness of psychological interventions for people with type 1 diabetes mellitus and people with type 2 diabetes mellitus so that they have improved (1) glycated haemoglobin levels, (2) diabetes self-management and (3) quality of life, and fewer depressive symptoms. The second objective was to determine the cost-effectiveness of psychological interventions. Data sources The following databases were accessed (searches took place between 2003 and 2016): MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycINFO, EMBASE, Cochrane Controlled Trials Register, Web of Science, and Dissertation Abstracts International. Diabetes conference abstracts, reference lists of included studies and Clinicaltrials.gov trial registry were also searched. Review methods Systematic review, aggregate meta-analysis, network meta-analysis, individual patient data meta-analysis and cost-effectiveness modelling were all used. Risk of bias of randomised and non-randomised controlled trials was assessed using the Cochrane Handbook (Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928). Design Systematic review, meta-analysis, cost-effectiveness analysis and patient and public consultation were all used. Setting Settings in primary or secondary care were included. Participants Adolescents and children with type 1 diabetes mellitus and adults with types 1 and 2 diabetes mellitus were included. Interventions The interventions used were psychological treatments, including and not restricted to cognitive–behavioural therapy, counselling, family therapy and psychotherapy. Main outcome measures Glycated haemoglobin levels, self-management behaviours, body mass index, blood pressure levels, depressive symptoms and quality of life were all used as outcome measures. Results A total of 96 studies were included in the systematic review (n = 18,659 participants). In random-effects meta-analysis, data on glycated haemoglobin levels were available for seven studies conducted in adults with type 1 diabetes mellitus (n = 851 participants) that demonstrated a pooled mean difference of –0.13 (95% confidence interval –0.33 to 0.07), a non-significant decrease in favour of psychological treatment; 18 studies conducted in adolescents/children with type 1 diabetes mellitus (n = 2583 participants) that demonstrated a pooled mean difference of 0.00 (95% confidence interval –0.18 to 0.18), indicating no change; and 49 studies conducted in adults with type 2 diabetes mellitus (n = 12,009 participants) that demonstrated a pooled mean difference of –0.21 (95% confidence interval –0.31 to –0.10), equivalent to reduction in glycated haemoglobin levels of –0.33% or ≈3.5 mmol/mol. For type 2 diabetes mellitus, there was evidence that psychological interventions improved dietary behaviour and quality of life but not blood pressure, body mass index or depressive symptoms. The results of the network meta-analysis, which considers direct and indirect effects of multiple treatment comparisons, suggest that, for adults with type 1 diabetes mellitus (7 studies; 968 participants), attention control and cognitive–behavioural therapy are clinically effective and cognitive–behavioural therapy is cost-effective. For adults with type 2 diabetes mellitus (49 studies; 12,409 participants), cognitive–behavioural therapy and counselling are effective and cognitive–behavioural therapy is potentially cost-effective. The results of the individual patient data meta-analysis for adolescents/children with type 1 diabetes mellitus (9 studies; 1392 participants) suggest that there were main effects for age and diabetes duration. For adults with type 2 diabetes mellitus (19 studies; 3639 participants), baseline glycated haemoglobin levels moderated treatment outcome. Limitations Aggregate meta-analysis was limited to glycaemic control for type 1 diabetes mellitus. It was not possible to model cost-effectiveness for adolescents/children with type 1 diabetes mellitus and modelling for type 2 diabetes mellitus involved substantial uncertainty. The individual patient data meta-analysis included only 40–50% of studies. Conclusions This review suggests that psychological treatments offer minimal clinical benefit in improving glycated haemoglobin levels for adults with type 2 diabetes mellitus. However, there was no evidence of benefit compared with control interventions in improving glycated haemoglobin levels for people with type 1 diabetes mellitus. Future work Future work should consider the competency of the interventionists delivering a therapy and psychological approaches that are matched to a person and their life course. Study registration This study is registered as PROSPERO CRD42016033619. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 28. See the NIHR Journals Library website for further project information.

Hypoglycemia The Major Barrier to Good Glycemic Control

2006 ◽  
Vol 00 (02) ◽  
Author(s):  
Stephen N Davis ◽  
Julia P Dunn
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Intensive Therapy ◽  
Good Glycemic Control ◽  
Major Barrier ◽  
The Us ◽  
Glycemic Targets ◽  
Pharmacologic Agents

Approximately 20.8 million Americans (14.6 million diagnosed and 6.2 million undiagnosed) have diabetes mellitus (diabetes) and in 2002 it was the sixth leading cause of death, emphasizing the need for improved treatment. However, iatrogenic hypoglycemia precludes reaching and maintaining euglycemia. During the Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS), outcomes of diabetes improved while hypoglycemia worsened with intensive therapy. The consequence was that hypoglycemia became the major obstacle to achieving the stated glycemic targets in these studies. As a result, hypoglycemia becomes a major barrier in improving outcomes in type 1 and type 2 diabetes. This has considerable financial implications as at least US$40 billion is spent each year in the US on complications of diabetes. Understanding the mechanisms and impact of hypoglycemia in diabetes is vital so that it can be addressed clinically. Furthermore, newer pharmacologic agents offer the clinician options to reduce iatrogenic hypoglycemia.

Type 2 Diabetes Overtakes Type 1 in Hispanic Girls

2008 ◽  
Vol 38 (15) ◽  
pp. 18
Author(s):  
SHERRY BOSCHERT
Keyword(s):  
Type 2 Diabetes
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