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Suboptimal behaviour and knowledge regarding overnight glycaemia in adults with type 1 diabetes is common
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.
NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia; Department of Diabetes and Endocrinology, St Vincent’s Hospital Melbourne and University of Melbourne, Melbourne, Victoria, Australia.
Department of Diabetes, Endocrinology and Metabolism, Northern Clinical School, The University of Sydney, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
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2018 (English)In: Internal medicine journal (Print), ISSN 1444-0903, E-ISSN 1445-5994, Vol. 48, no 9, p. 1080-1086Article in journal (Refereed) Published
Abstract [en]

Background

In people with type 1 diabetes (T1D), nocturnal hypoglycaemia (NH) can be slept through and can cause seizures, arrhythmias and death. Hypoglycaemia avoidance can induce hyperglycaemia and ketosis. Patient behaviour impacts clinical outcomes and may be changed by education.

Aim

To develop and utilise a survey to evaluate patient self‐management of overnight glycaemia in adults with T1D.

Methods

Adults with T1D attending two Australian tertiary referral diabetes clinics completed a survey about their diabetes self‐management and glycaemic control, including responses to hypothetical pre‐bed blood glucose (BG) levels (4–20 mmol/L). Statistical analyses included t‐tests, Chi square tests and ANOVA with significance considered at P < 0.05.

Results

There were 205 participants (103 females), with a mean (SD) age of 41 (17) years, T1D duration of 20 (16) years, HbA1c of 7.8(1.4)%, (61.3(8.2) mmol/mol), 38% on insulin pump therapy (CSII) and 36% with impaired hypoglycaemia awareness (IHA). Mean (SD) number of BG tests/day was 5.4 (2.7). Patients set higher BG target levels at bedtime and overnight: 7.5(1.4) and 7.1(1.3) mmol/L, respectively, compared to daytime (6.9(1.0); P < 0.0001 and P = 0.002 respectively). Only 36% of participants reported treating nocturnal hypoglycaemia (NH) with the recommended refined, then complex, carbohydrate. Only 28% of patients made safe choices in all bedtime BG scenarios, with higher rates for CSII users, P = 0.0005. Further education was desired by 32% of respondents, with higher rates in those with (44%) versus without IHA (25%), P = 0.006.

Conclusions

Many adults with T1D have suboptimal knowledge and behaviour regarding overnight BG self‐management. A survey, piloted herein, may facilitate the identification of patients who could benefit from further education.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018. Vol. 48, no 9, p. 1080-1086
Keywords [en]
type 1 diabetes; nocturnal hypoglycaemia; hyperglycaemia; self-management; diabetes education
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-151492DOI: 10.1111/imj.13798ISI: 000443684400009PubMedID: 29573166Scopus ID: 2-s2.0-85052817068OAI: oai:DiVA.org:liu-151492DiVA, id: diva2:1250691
Note

Funding Agencies|CSN (Centrala studiestodsnamnden); NHMRC; University of Sydney, Sydney Medical School Foundation

Available from: 2018-09-24 Created: 2018-09-24 Last updated: 2018-10-03Bibliographically approved

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Larsson, Christina R.Ludvigsson, Johnny
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Department of Clinical and Experimental MedicineFaculty of Medicine and Health SciencesDivision of Children's and Women's healthH.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus
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