Biological and behavioural determinants of the frequency of mild, biochemical hypoglycaemia in patients with Type 1 diabetes on multiple insulin injection therapy
Mmj. Janssen et al., Biological and behavioural determinants of the frequency of mild, biochemical hypoglycaemia in patients with Type 1 diabetes on multiple insulin injection therapy, DIABET M R, 16(3), 2000, pp. 157-163
Background Severe hypoglycaemic episodes are an important source of morbidi
ty in people with Type 1 diabetes. The occurrence of severe hypoglycaemia i
s strongly related to the frequency of low blood glucose readings. The aim
of this exploratory study was to identify determinants of the frequency of
mild, biochemical hypoglycaemia in patients with Type I diabetes treated wi
th multiple insulin injection therapy.
Methods We studied 31 patients with Type 1 diabetes in reasonable glycaemic
control (HbA(1c)less than or equal to 8.3%) during multiple injection ther
apy. The study had a prospective, observational design. We used standardise
d home blood glucose monitoring (HBGM) diaries to assess the frequency of h
ypoglycaemia (HBGM readings<3.5 mmol/L) over a period of 6 weeks. Potential
determinants studied included biological factors, self-management factors
(including weekly total physical activity and vigorous physical activity),
psychological factors (including psychological distress) and mediating fact
ors [average and standard deviation (SD) of the HBGM readings and self-repo
rted hypoglycaemia awareness].
Results Determinants of mild hypoglycaemia frequency identified in univaria
te regression analyses were: SD and mean of HBGM (beta 0.6, p = 0.001 and b
eta -0.6, p = 0.001), diabetes duration (beta 0.5, p = 0.008) and self-repo
rted hypoglycaemia unawareness (beta -0.5, p = 0.003). A trend was observed
for performance of vigorous physical activities (beta 0.3, p = 0.06) and e
xternal eating behaviour (beta -0.3, p = 0.1). These relations were confirm
ed in multivariate analyses.
Conclusions Patients with Type I diabetes who have a high blood glucose var
iability and low average blood glucose concentration, diabetes of long dura
tion, low body mass index, self-reported impaired awareness of hypoglycaemi
a and those participating in vigorous physical activities, specifically req
uire interventions aimed at preventing hypoglycaemia. Copyright (C) 2000 Jo
hn Wiley & Sons, Ltd.