Quality of life reduced in diabetes patients who fear hypoglycemic events
MedWire News: Hypoglycemic symptoms are associated with reduced quality of life and increased fear of hypoglycemia in patients with Type 2 diabetes treated with antihyperglycemic agents (AHAs), show study findings.
These patients' health related quality of life (HRQoL) could be improved byaddressing their worries about hypoglycemia, as well as their hypoglycemic symptoms, say Siew-Pheng Chan (University of Malaya, Kuala Lumpar, Malaysia) and colleagues.
The team investigated whether self-reported hypoglycemic symptoms are associated with HRQoL and worry about hypoglycemia in 2257 Type 2 diabetes patients enrolled in the Real-Life Effectiveness and Care Patterns of Diabetes Management (RECAP) Asia-Pacific study.
All patients had been treated with AHAs for at least 6 months at the time of study entry. The study participants completed questionnaires to provide information on the frequency and severity of any hypoglycemic symptoms (eg, sweating, dizziness, shakiness, and confusion) they had experienced in the 6 months prior to enrollment. They also described their HRQoL and the degree to which they worried about hypoglycemia.
HRQoL was measured using the EuroQol Visual Analog Scale (EQ-VAS, score range 0 to 100) and the EuroQol-5 Dimensions (EQ-5D) questionnaire (including a linear version, score range -0.59 to 1.00), and degree of worry was quantified using the Hypoglycemia Fear Survey-II (HFS).
The researchers report that most of the patients were taking a combination of AHAs, either metformin and a sulfonylurea (37.1%) or other combinations (35.1%). In addition, 38.5% of the patients reported symptoms of hypoglycemia, 58.5% of which were mild, 21.7% moderate, 11.6% severe, and 8.2% very severe.
Analysis showed that HRQoL was significantly lower among patients reporting hypoglycemic symptoms than among those who did not report symptoms, with EQ-VAS scores of 73.6 versus 76.9 and EQ-5D scores of 0.88 versus 0.90.
In addition, a significantly greater proportion of patients experiencing hypoglycemic symptoms reported at least some problems on three of the EQ-5D domains, compared with those reporting no symptoms. Specifically, 7.7% of those with symptoms versus 5.1% without symptoms reported problems performing their usual activities, 37.5% versus 26.4% had problems with pain and discomfort, and 27.7% versus 17.6% experienced problems with anxiety/depression.
The authors also found that the mean HFS worry score was significantly greater for patients with hypoglycemic symptoms than it was in those without (12.5 vs 6.3) and that level of fear increased with symptom severity.
The authors say there is currently some evidence that training patients to recognize and avoid severe hypoglycemic episodes may reduce their fear of hypoglycemia.
"Diabetes management strategies that simultaneously reduce episodes of hypoglycemia and maintain glycemic control may improve patients' quality of life," they conclude in Diabetes Research and Clinical Practice.
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Sally Robertson