Associations Between Hypoglycemia Awareness, Hypoglycemia Beliefs, and Continuous Glucose Monitoring Glycemic Profiles and Anxiety and Depression Symptoms in Adults with Type 1 Diabetes Using Advanced Diabetes Technologies

Yu Kuei Lin; Emily Hepworth; Nicole de Zoysa; Jessica McCurley; Mary Ellen Vajravelu; Wen Ye; Gretchen A Piatt; Stephanie A Amiel; Simon J Fisher; Rodica Pop-Busui; James E Aikens

doi:10.1016/j.diabres.2023.111059

Associations Between Hypoglycemia Awareness, Hypoglycemia Beliefs, and Continuous Glucose Monitoring Glycemic Profiles and Anxiety and Depression Symptoms in Adults with Type 1 Diabetes Using Advanced Diabetes Technologies

Diabetes Res Clin Pract. 2023 Dec 15:111059. doi: 10.1016/j.diabres.2023.111059. Online ahead of print.

Authors

Affiliations

¹ Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA. Electronic address: yuklin@med.umich.edu.
² Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
³ Department of Diabetes, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK.
⁴ Department of Psychology, San Diego State University, San Diego, CA 92182, USA.
⁵ Center for Pediatric Research in Obesity and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA.
⁶ Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48105, USA.
⁷ Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
⁸ Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Kings College London, London SE5 9RJ, UK.
⁹ Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40508, USA.
¹⁰ Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.

PMID: 38104898
DOI: 10.1016/j.diabres.2023.111059

Abstract

Aims: To evaluate relationships between hypoglycemia awareness, hypoglycemia beliefs, and continuous glucose monitoring (CGM) glycemic profiles and anxiety and depression symptoms in adults with type 1 diabetes (T1D) who use CGM or automated insulin delivery devices.

Methods: A cross-sectional survey and data collections were completed with 196 T1D adults who used advanced diabetes technologies. We assessed hypoglycemia awareness (Gold instrument), hypoglycemia beliefs (Attitudes to Awareness of Hypoglycemia instrument), CGM glycemic profiles, demographics, and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Data were processed via regression analyses and receiver operating characteristic analyses.

Results: Lower hypoglycemia awareness, weaker "hypoglycemia concerns minimized" beliefs, stronger "hyperglycemia avoidance prioritized" beliefs, female, and younger age were independently associated with higher anxiety symptoms (P<0.05). Lower hypoglycemia awareness, less time in hypoglycemia, and younger age were independently associated with greater depression symptoms (P<0.05). Age of <50 years had 77.8% sensitivity and 48.8% specificity in detecting elevated anxiety symptoms. Spending ≥35% of time with glucose levels >180 mg/dL on CGMs had 85.7% sensitivity and 54.3% specificity in detecting elevated depression symptoms.

Conclusion: Our findings revealed relationships between impaired hypoglycemia awareness, hypoglycemia beliefs, CGM-detected hypoglycemia and anxiety and depression symptoms in T1D adults who use advanced diabetes technologies.

Keywords: Anxiety; continuous glucose monitoring; depression; hypoglycemia; type 1 diabetes.