OBJECTIVES : Severe hypos can be debilitating for patients and can be associated with anxiety and/or depression [A+/-D]. The objective of this analysis is to consider the incremental impact of A+/-D in patients who experience severe hypos.

METHODS : Data were drawn from 2016 Adelphi Disease Specific Programme, a real-world, cross-sectional study in 5EU/USA. Physicians completed forms for the next 2 T1DM patients capturing comorbidities (including anxiety, depression), demographics, disease duration, hypo severity [mild: self-managed, severe: requiring non-medical or medical help], resource utilization. Patients self-reported work, activity impairment, lifestyle impact. To assess differences OLS regressions were conducted for continuous outcomes and logit models for binary outcomes. Regressions accounted for confounding variables: gender, disease duration, BMI. The independent variable was no physician-reported A+/-D vs. A+/-D.

RESULTS : Of 1662 patients, 861 (51.8%) never experienced hypos, 637 (38.3%) mild and 164 (9.9%) severe. Of those patients with severe hypos, 27 (16.5%) had A+/-D. Diagnosis of A+/-D was associated with increased time missed from work, (+30.21%, n=37, p<0.001), no difference was observed in productivity while at work. These patients had 2.29 more physician consultations than those without A+/-D (n=131, p=0.031). They also had a greater need for caregiver involvement, although not statistically significant (n=130, p=0.051). Regarding lifestyle, these patients were more likely to be in the sometimes/greatly affected category for appearance/self-confidence issues (OR coefficient:13.54, base=1, n=80, p=0.002), although factors such as freedom to eat/drink, take long journeys, feelings about the future, impact on leisure activities were similar.

CONCLUSIONS : This study demonstrated there is significant incremental burden of anxiety and depression in T1DM patients who experience severe hypos. Physicians should take steps to recognize and manage these conditions.