Recall of severe hypoglycaemia and self‐estimated state of awareness in type 1 diabetes

Pedersen‐Bjergaard, Ulrik; Pramming, Stig; Thorsteinsson, Birger

doi:10.1002/dmrr.377

Cited by 240Diabetes Management and ResearchDiabetes Management and EducationPatient Safety and Medication Errors

Recall of severe hypoglycaemia and self‐estimated state of awareness in type 1 diabetes

Pedersen‐Bjergaard, Ulrik, Pramming, Stig, Thorsteinsson, Birger·2003·Diabetes/Metabolism Research and Reviews

DOI 10.1002/dmrr.377

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Abstract

Background The ability of people with insulin-treated diabetes to remember severe hypoglycaemia and the consistency of their self-estimated awareness of hypoglycaemia are not well documented but are important in clinical practice. The aim of this study is to assess recall of severe hypoglycaemia in patients with type 1 diabetes and to evaluate the feasibility of a simple method for clinical classification of the awareness of hypoglycaemia. Methods A one-year prospective study was performed on a cohort of patients with type 1 diabetes (n = 230). The rate of severe hypoglycaemia reported retrospectively at the end of the study was compared to the prospectively recorded rate during the study period. Self-estimated awareness was explored in questionnaires at baseline and at the end, and assessments were evaluated by the occurrence of severe hypoglycaemic episodes. Results Almost 90% of the participants correctly recalled whether they had had severe hypoglycaemia. However, those with high prospectively recorded numbers had incomplete recall, resulting in a 15% underestimation of the overall rate. On the basis of the answer to the question "Do you recognise symptoms when you have a hypo?", the population was classified into three groups: 40% with normal awareness, 47% with impaired awareness and 13% with unawareness. The groups with impaired awareness and unawareness had 5.1 and 9.6 times higher rates of severe hypoglycaemia, respectively, compared to the group with normal awarenes…

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The Pedersen-Bjergaard et al. questionnaire and Hypoglycemia Awareness Questionnaire (HypoA-Q) can also identify IAH.
“The Pedersen-Bjergaard et al. questionnaire and Hypoglycemia Awareness Questionnaire (HypoA-Q) can also identify IAH (118,119).”
From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [118]

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Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia
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Background
Breastfeeding at night is rarely followed by hypoglycaemia in women with type 1 diabetes using carbohydrate counting and flexible insulin therapy
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Fear of hypoglycaemia in adults with Type 1 diabetes: results from Diabetes MILES – The Netherlands
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Clinical approaches to treat impaired awareness of hypoglycaemia
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Hypoglycemia-associated autonomic failure in diabetes
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Cognitive deficits associated with impaired awareness of hypoglycaemia in type 1 diabetes
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“The lack of correlation between the frequency of SH episodes and cognitive test results may indicate that the observed association between IAH and cognitive deficits did not result from exposure to SH; instead, it might be explained by inaccurate recall of SH episodes, since it is known that retrospective estimation o…”
Unexplained Hypoglycaemia and Large Glycaemic Variability: Skin Lipohypertrophy as a Predictive Sign
Strollo, F., Guarino, G., Armentano, V., Clemente, G., Martedì, E., Riu, S. D., Gaeta, I., Corigliano, G., Ceriello, A., & Gentile, S. (2016) · Diabetes Research - Open Journal · doi:10.17140/droj-2-126 · Cited by 28 · see citing works
The Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE): study protocol for a cluster randomised controlled trial
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Dietary Advice to Support Glycaemic Control and Weight Management in Women with Type 1 Diabetes during Pregnancy and Breastfeeding
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Cognitive, behavioural and psychological barriers to the prevention of severe hypoglycaemia: A qualitative study of adults with type 1 diabetes
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Genetic Variation and Activity of the Renin-Angiotensin System and Severe Hypoglycemia in Type 1 Diabetes
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Self-citation
The impact of non-severe hypoglycemia on quality of life in patients with type 2 diabetes
Polonsky, W. H., Fisher, L., & Hessler, D. (2018) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2018.01.014 · Cited by 27 · see citing works
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Influence of health locus of control and fear of hypoglycaemia on glycaemic control and treatment satisfaction in people with Type 1 diabetes on insulin pump therapy
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Lower levels of circulating IGF‐I in Type 1 diabetic women with frequent severe hypoglycaemia during pregnancy
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Self-citation
The impact of hypoglycaemia on quality of life among adults with type 1 diabetes: Results from “YourSAY: Hypoglycaemia”
Chatwin, H., Broadley, M. M., Hendrieckx, C., Carlton, J., Heller, S. R., Amiel, S. A., de Galan, B. E., McCrimmon, R. J., Pedersen‐Bjergaard, U., Pouwer, F., et al. (2022) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2022.108232 · Cited by 23 · see citing works
Self-citation
Asymptomatic hypoglycaemia in Type 1 diabetes: incidence and risk factors
Henriksen, M. M., Andersen, H. U., Thorsteinsson, B., & Pedersen‐Bjergaard, U. (2018) · Diabetic Medicine · doi:10.1111/dme.13848 · Cited by 26 · see citing works
Self-citation
The Impact of Nocturnal Hypoglycemia on Sleep in Subjects With Type 2 Diabetes
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“tified by asking subjects, “Do you recognize symptoms when you have a hypo,” with answers categorized as “always,” “usually,” “occasionally,” “never,” or “don’t know,” according to previous research (13,14).”
Professional Continuous Glucose Monitoring in Subjects with Type 1 Diabetes: Retrospective Hypoglycemia Detection
Jensen, M. H., Christensen, T. F., Tarnow, L., Mahmoudi, Z., Johansen, M. D., & Hejlesen, O. K. (2013) · Journal of Diabetes Science and Technology · doi:10.1177/193229681300700116 · Cited by 26 · see citing works
Flash glucose monitoring and automated bolus calculation in type 1 diabetes treated with multiple daily insulin injections: a 26 week randomised, controlled, multicentre trial
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“At baseline, hypoglycaemia awareness was also assessed [29, 30].”
Self-citation
Diabetes Management During Breastfeeding in Women with Type 1 Diabetes
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Prospective and retrospective recording of severe hypoglycaemia, and assessment of hypoglycaemia awareness in insulin‐treated Type 2 diabetes
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Self-citation
Severe (level 3) hypoglycaemia occurrence in a real‐world cohort of adults with type 1 or 2 diabetes mellitus ( <scp>iNPHORM</scp> , United States)
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“Evidence asserts that the accuracy of past-year SH recall is 90%, 40 an estimate that may be even higher in our study as events were elicited up to monthly.”
BackgroundInfluential
Hypoglycemia-induced EEG complexity changes in Type 1 diabetes assessed by fractal analysis algorithm
Scarpa, F., Rubega, M., Zanon, M., Finotello, F., Sejling, A., & Sparacino, G. (2017) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2017.06.004 · Cited by 21
The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting
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“Recall of severe hypoglycaemia is well preserved during a one-year period [15].”
BackgroundMethodInfluentialSelf-citation
Living with cystic fibrosis-related diabetes or type 1 diabetes mellitus: a comparative study exploring health-related quality of life and patients' reported experiences of hypoglycaemia
Tierney, S., Webb, A. K., Jones, A. M., Dodd, M. E., McKenna, D., Rowe, R., Whitehouse, J. L., & Deaton, C. (2008) · Chronic Illness · doi:10.1177/1742395308094240 · Cited by 20 · see citing works
“Awareness of hypoglycaemia often decreases as duration of diabetes increases,(27,28) which could explain why only individuals from the T1DM group recorded having: (1) no symptoms prior to such an episode in their diary; and (2) more neuroglycopenic symptoms on the EHS, symptoms that tend to predominate (over autonomic…”
Comparing effects of insulin analogues and human insulin on nocturnal glycaemia in hypoglycaemia‐prone people with Type 1 diabetes
Kristensen, P. L., Tarnow, L., Bay, C., Nørgaard, K., Jensen, T., Parving, H. ‐., Perrild, H., Beck‐Nielsen, H., Christiansen, J. S., Thorsteinsson, B., et al. (2017) · Diabetic Medicine · doi:10.1111/dme.13317 · Cited by 18 · see citing works
Self-citation
Association between hypoglycaemia and impaired hypoglycaemia awareness and mortality in people with Type 1 diabetes mellitus
Sejling, A., Schouwenberg, B., Færch, L., Thorsteinsson, B., de Galan, B. E., & Pedersen‐Bjergaard, U. (2015) · Diabetic Medicine · doi:10.1111/dme.12810 · Cited by 19 · see citing works
Self-citation
An Evaluation of Methods of Assessing Impaired Awareness of Hypoglycemia in Type 1 Diabetes
Pedersen-Bjergaard, U., Høi-Hansen, T., & Thorsteinsson, B. (2007) · Diabetes Care · doi:10.2337/dc07-1181 · Cited by 20 · see citing works
“justify their approach by reference to one single study (4), ignoring our methodological study (5)—which is familiar to them—and other studies describing and using the current method (6).”
BackgroundMethodSelf-citation
Sense of coherence and power among people with blindness caused by diabetes.
Leksell, J., Wikblad, K., & Sandberg, G. E. (2005) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2004.06.002 · Cited by 20
“This is in accordance with other studies among blind patients [4,5,7,8] and patients with long diabetes duration [19–21].”
Result
Factors associated with hypoglycemia unawareness and severe hypoglycemia in type 1 diabetes mellitus patients
Takagi, S., Miura, J., Takita, M., Mochizuki, S., Asanuma, T., Hoshina, S., Takaike, H., Uchigata, Y., & Babazono, T. (2022) · Journal of Diabetes Investigation · doi:10.1111/jdi.13886 · Cited by 19 · see citing works
Patient-reported frequency, awareness and patient-physician communication of hypoglycaemia in Belgium
Peene, B., D’Hooge, D., Vandebrouck, T., & Mathieu, C. (2014) · Acta Clinica Belgica · doi:10.1179/2295333714y.0000000050 · Cited by 19 · see citing works
Hypoglycemia-Associated EEG Changes Following Antecedent Hypoglycemia in Type 1 Diabetes Mellitus
Sejling, A., Kjær, T. W., Pedersen‐Bjergaard, U., Remvig, L. S., Frandsen, C. S., Hilsted, L., Faber, J. O., Holst, J. J., Tarnow, L., Møller, J. S., et al. (2017) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2016.0331 · Cited by 19 · see citing works
Self-citation
Risk of recurrent severe hypoglycemia remains associated with a past history of severe hypoglycemia up to 4 years: Results from a large prospective contemporary pediatric cohort of the DPV initiative
Pacaud, D., Hermann, J., Karges, B., Rosenbauer, J., Danne, T., Dürr, R., Herbst, A., Lindauer, S. P., Müther, S., Pötzsch, S., et al. (2017) · Pediatric Diabetes · doi:10.1111/pedi.12610 · Cited by 20 · see citing works
Hypoglycemia in patients with insulin‑treated diabetes.
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Observational Study of Once-Daily Insulin Detemir in People with Type 2 Diabetes Aged 75 Years or Older
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“Recall reliability of minor hypoglycaemia amongst patients with insulindependent T2DM is unknown [28], but in people with type 1 diabetes, it has been found to be poor after 1 week [29, 30].”
Background
A prospective randomised cross-over study of the effect of insulin analogues and human insulin on the frequency of severe hypoglycaemia in patients with type 1 diabetes and recurrent hypoglycaemia (the HypoAna trial): study rationale and design
Kristensen, P. L., Pedersen‐Bjergaard, U., Beck‐Nielsen, H., Nørgaard, K., Perrild, H., Christiansen, J. S., Jensen, T. J., PARVING, H.-H. D., Thorsteinsson, B., & Tarnow, L. (2012) · BMC Endocrine Disorders · doi:10.1186/1472-6823-12-10 · Cited by 18 · see citing works
“State of hypoglycaemia awareness is classified by a validated method [26-27].”
Self-citation
Comparison of treatment with insulin degludec and glargine <scp>U100</scp> in patients with type 1 diabetes prone to nocturnal severe hypoglycaemia: The <scp>HypoDeg</scp> randomized, controlled, open‐label, crossover trial
Pedersen‐Bjergaard, U., Agesen, R. M., Brøsen, J. M. B., Alibegovic, A. C., Andersen, H. U., Beck‐Nielsen, H., Gustenhoff, P., Hansen, T. K., Hedetoft, C., Jensen, T. J., et al. (2022) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.14574 · Cited by 16 · see citing works
Self-citation
Current and future therapies to treat impaired awareness of hypoglycemia
Macon, E. L., DEVORE, M. H., Lin, Y. K., MUSIC, M. B., WOOTEN, M., McMullen, C. A., Woodcox, A. M., MARKSBURY, A. R., Beckner, Z., Patel, B. V., et al. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1271814 · Cited by 20 · see citing works
Factors associated with greater benefit of a national reimbursement policy for blood glucose test strips in adult patients with type 1 diabetes: A prospective cohort study
Jin, S.-M., Baek, J., Suh, S., Jung, C.-H., Lee, W.-J., Park, C.-Y., Yang, H., Cho, J.-H., Lee, B.-W., & Kim, J. H. (2017) · Journal of Diabetes Investigation · doi:10.1111/jdi.12728 · Cited by 16 · see citing works

Authors: Pedersen‐Bjergaard, U., Pramming, S., & Thorsteinsson, B.
Affiliations: Capital Region of Denmark (DK)
Novo Nordisk (Denmark) (DK)
Corresponding author: Pedersen‐Bjergaard, Ulrik
ORCID: Pedersen‐Bjergaard, Ulrik
Venue: Diabetes/Metabolism Research and Reviews
Publisher: Wiley
Published: 2003-04-10
Volume: 19
Issue: 3
Pages: 232-240
ISSN: 1520-7552 (ISSN-L)
1520-7560
DOI: 10.1002/dmrr.377
OpenAlex: W2087712389
Cited by: 240
References: 0
Citations by year: 2026: 10 · 2025: 10 · 2024: 12 · 2023: 12 · 2022: 11 · 2021: 16 · 2020: 10 · 2019: 10 · 2018: 15 · 2017: 19 · 2016: 13 · 2015: 10 · 2014: 20 · 2013: 14 · 2012: 10
FWCI: 2.65
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Diabetes/Metabolism Research and Reviews (publishedVersion)
PubMed (publishedVersion)
Funders: Novo Nordisk Fonden
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords: type 1 diabetes, severe hypoglycemia, hypoglycemia awareness, hypoglycemia unawareness
MeSH terms: Awareness, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Humans, Hypoglycemia, Male, Memory, Middle Aged, Outpatients, Prospective Studies, Surveys and Questionnaires, Records, Regression Analysis, Age of Onset

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Recall of severe hypoglycaemia and self‐estimated state of awareness in type 1 diabetes

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