The Psychosocial Burden of Severe Hypoglycemic Events and Impaired Awareness of Hypoglycemia in Adult Continuous Glucose Monitor Users: Results From a Cross-Sectional Survey Study

OBJECTIVES: To describe the psychosocial burden of severe hypoglycemic events (SHEs) and impaired awareness of hypoglycemia (IAH) in adult continuous glucose monitor (CGM) users with type 1 diabetes (T1D).

METHODS: Participants (≥18 years) completed an online survey including the Hypoglycemia Fear Survey (HFS-II; higher score=greater fear of hypoglycemia), Patient Health Questionnaire-4 items (PHQ-4); clinical cut-off: score ≤2= normal, 3-5=mild, 6-8=moderate, 9-12=severe) and measures of SHE frequency and IAH status (modified Gold score ≤2=no impairment (IAH-); 3=borderline (undetermined); ≥4=impaired awareness (IAH+)). Cohorts were created based on SHE frequency in the past year and IAH status: Problematic SHEs (2+ SHEs/IAH-; 1+ SHE/IAH+), Single SHE/No-IAH (1 SHE/IAH-), Undetermined IAH (≥0 SHE/IAH=3), and No-SHE (0 SHE/IAH+; 0 SHE/IAH-). Results were stratified by insulin delivery methods: multiple daily injections (MDI), predictive low glucose suspend (PLGS), hybrid closed-loop system/do-it-yourself (HCLS/DIY) and pump without automated insulin delivery (pump-no-AID). HFS-II and PHQ-4 were scored according to their published scoring algorithms. Descriptive results (mean, standard deviation [SD], counts, percentages) of participant characteristics were reported.

RESULTS: Overall, the Problematic SHEs cohort reported higher elevations of anxiety/depressive symptoms relative to the No-SHE cohort (Mean 3.3 [SD=3.3] vs. 2.4 [SD=2.7]). The mean PHQ-4 total score for the Problematic SHEs cohort was 3.3(SD=3.5), 4.0(SD=3.2), 3.2(SD=3.2), and 3.2(SD=3.5), whereas the No-SHE cohort reported 2.4(SD=3.0), 2.1(SD=2.6), 2.4(SD=2.7) and 2.4(SD=2.6), respectively. The mean HFS-II total score for the Problematic SHEs cohort was 55.2 (SD=27.3), 55.1 (SD=24.7), 52.2 (SD=23.2) and 47.5 (SD=23.1), whereas the No-SHE cohort reported 38.3 (SD=22.2), 35.0 (SD=19.3), 33.7 (SD=19.0), 38.0 (SD=22.5) for MDI, PLGS, HCLS/DIY, and pump-no-AID, respectively.

CONCLUSIONS: High psychosocial burden was observed in adult CGM users with T1D experiencing multiple SHEs and/or IAH, regardless of insulin delivery method used.