PracticeUpdate: Conference Series | ADC 2018

‘Problematic Hypoglycemia in Adults With T1D Can Be Avoided’ Structured education and clinician support may allay patients’ fear of hypoglycemia. BY THE PRACTICEUPDATE EDITORIAL TEAM

A n Australian health psychologist has called for more open discussion about hypoglycemia in the clinic, saying it needs to become part of routine conversation between clinicians and their patients with type 1 diabetes (T1D). Severe hypoglycemia is currently thought to affect 1 in 5 patients in specialist T1D centers. Severe hypoglycemia is independent of HbA1c. Patients with T1D often fear hypoglycemia and take compensatory measures to cope with their risk of hypoglycemia. “These fears are common among adults with type 1 diabetes and also among their family mem- bers,” said Jane Speight, PhD, CPsychol FBPsP, Foundation Director of the Australian Centre for Behavioural Research in Diabetes. Dr. Speight, who also holds the Chair in Behavioural and Social Research in Diabetes at Deakin University in Victoria, Australia, said that talking about hypoglycemia and any related fears can be challenging for some patients, but clinicians can handle these discussions in a sensitive and nonjudgemental way to allay these fears. “Talking about hypoglycemia can be challenging and some patients are reluctant to talk about it. “They fear being blamed for doing something wrong. Some even fear the perceived nega- tive consequences, such as losing their driving license, if they have these conversations with us,” Dr. Speight said.

She added that, on the flip side, many health pro- fessionals feel that they do not have the tools to offer support to adults with T1D to deal with their fear of hypoglycemia. In the HypoCOMPaSS trial published in 2014, 96 adults with long-standing T1D with impaired awareness of hypoglycemia and suffering recur- rent severe hypoglycemia said that they worried about their blood glucose (58%) and the long-term complications of diabetes (51%). They also said that they worried about not rec- ognizing high blood glucose (30%), diabetic ketoacidosis (25%), and their doctor’s reaction to their high blood glucose (24%). These patients also exhibited compensatory behaviors, such as taking extra insulin if blood glucose exceeded 7 mmol/L, intentionally keeping blood glucose low, and undertreating low blood glucose. Some even said that they were comfort- able with hypoglycemia and exercising if blood glucose is high. “These are quite concerning behaviors and worries among this group of people who have recurrent severe hypoglycemia,” Dr. Speight said. In her own interviews with 17 adults with long-stand- ing T1D and recurrent severe hypoglycemia, Dr. Speight found that these patients exhibited psychological as well as behavioural issues aimed at preventing hypoglycemia. They included not acting or acting too late to raise low glucose levels, not having an appro- priate action plan to guide self-care, and being

" It’s time to restore balance about risks. Yes, complications are serious but we need to share the good news with our patients that all reductions in HbA1c can reduce the risk of long-term complications. They also need to be aware that hypoglycemia is not inevitable – it’s not a necessary evil . " PRACTICEUPDATE CONFERENCE SERIES • ADC 2018 4