Self-Report of Hypoglycemia and Health-Related Quality of Life in Patients with Type 1 and Type 2 Diabetes
Objective: To establish the prevalence of patient-reported hypoglycemia among ambulatory patients with diabetes and assess its impact on health-related quality of life (HRQoL).Methods: This study was a cross-sectional analysis of a postal survey disbursed during quarter 1 of 2010 to 875 adults with type 1 or 2 diabetes identified on the basis of an index clinical encounter for diabetes management between August 1, 2005 and June 30, 2006. The survey included questions about hypoglycemia, self-rating of health, and questions adapted from the Confidence in Diabetes Self-Care, Generalized Anxiety Disorder-7, EuroQol5-D, and Hypoglycemic Fear Survey. Data was analyzed using two sample t-test for continuous and Chi-square for categorical variables, with multivariate analysis to adjust for age, gender, diabetes duration, and Charlson comorbidity index.Results: The survey was completed by 418 patients (47.8% response rate). Of the respondents, 26 of 92 (28.3%) with type 1 and 55 of 326 (16.9%) with type 2 diabetes reported at least one episode of severe hypoglycemia within 6 months. Fear of hypoglycemia, including engagement in anticipatory avoidance behaviors, was highest in patients with type 2 diabetes reporting severe hypoglycemia and all patients with type 1 diabetes (p < 0.001). HRQoL was lower in patients with type 2, but not type 1, diabetes reporting severe hypoglycemia (p < 0.01).Conclusion: Clinicians and health systems should incorporate screening for hypoglycemia into routine health assessment of all patients with diabetes. It places patients at risk for counterproductive behaviors, impairs HRQoL, and should be used in individualizing glycemic goals.
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