Letter to the Editor
Comments on “Impaired awareness of hypoglycaemia in subjects with type 1 diabetes”
Comentarios sobre «Hipoglucemia desapercibida en personas con diabetes tipo 1»
Florentino Carral San Laureano
, María del Carmen Ayala Ortega, Antonia Piñero Zaldivar, Coral Expósito
Corresponding author
Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, Spain
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Conget et al. on the results of their study on the impaired awareness of hypoglycemia (IAH) in patients with type 1 diabetes mellitus (T1DM),<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> where the authors report that approximately a quarter of patients with T1DM who completed an online survey had an abnormal perception of hypoglycemia. In order to ascertain whether our population with T1DM had an IAH rate as high as reported by these authors, in April 2016 we assessed the results in the Clarke test, validated in Spanish,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> of 100 patients (57% males) with T1DM (mean age: 35.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.8 years; time since TDM onset: 16.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.6 years; mean HbA1c: 7.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.1%) consecutively attending the monographic T1DM clinic who were on basal-bolus therapy (mean insulin dose: 0.76<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4<span class="elsevierStyleHsp" style=""></span>IU/kg/day). In this population, 25% were found to have an abnormal perception of hypoglycemia, 10% an indeterminate perception, and 65% a normal perception. These results are very similar to those reported by I. Conget et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> and other authors.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> As compared to patients with normal perceptions, those with IAH were older (41.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.8 vs 33.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.2 years; <span class="elsevierStyleItalic">p</span>: 0.019), had a longer duration of diabetes (22.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.3 vs 15.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.7 years; <span class="elsevierStyleItalic">p</span>: 0.032), and had experienced a higher number of severe hypoglycemic episodes over the previous 6 months (1.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.3 vs 0.15<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.83; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). No differences were seen, however, in the Clarke test score between the sexes or as a function of the current HbA1c level or the mean HbA1c level over the previous five years.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Hypoglycemia is possibly the greatest limiting factor for achieving optimum metabolic control in patients with T1DM.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> IAH in these patients represents a serious barrier to adequate disease control, impairs quality of life,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> and increases the risk of the development of severe hypoglycemia.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,6</span></a> Strategies (such as completion of the Clarke test) should therefore be implemented to allow for the early identification of these patients in order to improve their diabetes education (adequate nutrition, adjustments with exercise, etc.), readjust their control goals (at least temporarily),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> and optimize their insulin therapy, in an attempt to improve their perception of and response to hypoglycemia and to decrease their risk of developing severe hypoglycemia in the future.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Carral San Laureano F, Ayala Ortega MC, Piñero Zaldivar A, Expósito C. Comentarios sobre «Hipoglucemia desapercibida en personas con diabetes tipo 1». Endocrinol Nutr. 2016;63:435.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[article in English, Spanish]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impaired awareness of hypoglycaemia in subjects with type 1 diabetes. Results of an online survey in a diabetes web site" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Conget" 1 => "D. Ávila" 2 => "M. Giménez" 3 => "C. Quiros" 4 => "V. Salaverria" 5 => "B. Dueñas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.endonu.2015.11.003" "Revista" => array:6 [ "tituloSerie" => "Endocrinol Nutr" "fecha" => "2016" "volumen" => "63" "paginaInicial" => "121" "paginaFinal" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26818085" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[article in Spanish]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychometric analysis of the Spanish and Catalan versions of a questionnaire for hypoglycemia awareness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Jansa" 1 => "C. Quiros" 2 => "M. Gimenez" 3 => "M. Vidal" 4 => "M. Galindo" 5 => "I. 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Cryer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra031354" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2004" "volumen" => "350" "paginaInicial" => "2272" "paginaFinal" => "2279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15163777" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.R. Seaquist" 1 => "J. Anderson" 2 => "B. Childs" 3 => "P. Cryer" 4 => "S. Dagogo-Jack" 5 => "L. Fish" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc12-2480" "Revista" => array:7 [ "tituloSerie" => "Diabetes Care" "fecha" => "2013" "volumen" => "36" "paginaInicial" => "1384" "paginaFinal" => "1395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23589542" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0034935610702139" "estado" => "S300" "issn" => "00349356" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735093/0000006300000008/v2_201704140444/S2173509316300897/v2_201704140444/en/main.assets" "Apartado" => array:4 [ "identificador" => "8667" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735093/0000006300000008/v2_201704140444/S2173509316300897/v2_201704140444/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509316300897?idApp=UINPBA00004N" ]
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