More than 300,000 people in the UK live with type 1 diabetes and nearly half of those will experience a severe hypoglycaemic episode every year. ‘Hypos’, as they are commonly known, are caused by low blood glucose (sugar) and can result in confusion, collapses, fitting and, in extreme cases, even sudden death.
Severe hypos can have a huge impact on the lives of people with type 1 diabetes and their families. Unpleasant symptoms and consequences of severe hypos can lead to fear of hypoglycaemia and reduce independence and spontaneity, which are both important for quality of life. Hypos also put pressure on family and friends, who need to provide assistance to help the person recover. Those who experience repeated severe hypos are often prevented from driving and can face employment difficulties.
In the first few years after being diagnosed, people with type 1 diabetes will experience early warning signs of an impending hypo, such as sweating or shaking, which will give them time to eat or drink something sugary before they become incapacitated. But it has long been known that people who have type 1 diabetes for more than five years can start to lose these warning symptoms, placing them at very high risk of a hypo both when awake and while asleep.
In a multi-centre study, diabetes experts at the University of Cambridge and Addenbrooke’s Hospital found that the vast majority of people with type 1 diabetes can regain their hypo warning signs and avoid these traumatic experiences – even after many years of insulin therapy.
The hypoCOMPaSS study, funded by Diabetes UK, is published today (Thurs) in the journal Diabetes Care.
Dr Mark Evans, lecturer at University of Cambridge and consultant at Addenbrooke’s, said: ”This important study demonstrates that with a targeted management programme, many more people can avoid the frightening and potentially life-threatening effects of hypos. We hope this research will help healthcare professionals across the country offer better care for their patients with Type 1 diabetes.”
At Addenbrooke’s, a multidisciplinary team of diabetes consultants, diabetes specialist nurses and dieticians run a number of different clinics through the week for patients with type 1 diabetes. Co-location with the diabetes specialist foot service, retinal screening and point of care testing of average blood sugar levels, allows a one stop shop approach to diabetes.
In the study 96 adults with type 1 diabetes from across the country were asked to follow simple guidelines for adjusting their insulin doses to minimise low glucose levels and took part in a brief education session to provide them with a ‘hypo compass’. This provided a framework for preventing progression of mild hypos into dangerous events through a range of practical strategies remembered through the points of a compass.
The study also compared the impact of different approaches to insulin delivery (pumps versus injections) and glucose monitoring (continuous glucose monitoring versus conventional finger-prick testing) on the avoidance of hypos.
Before the study, those who took part had been experiencing around 10 dangerous hypos every year. However, during the six-month trial period 80% of them experienced no further attacks.
This study has confirmed the need for access to best possible guidance and structured support for everyone with type 1 diabetes to enable them to achieve good control without disabling hypoglycaemia. This level of health care professional input has often been reserved for those using new technologies including insulin pumps and continuous glucose monitors, but this study shows it needs to be provided equally to all.
The study was led by Newcastle University involved teams from Cambridge, Sheffield, Bournemouth and Plymouth Universities, as well as health psychologists from AHP Research and Deakin University (Australia).
The trial showed that equivalent benefits could be achieved using insulin injections or an insulin pump. Similarly regular finger prick testing including some night-time checks was just as effective as real time continuous glucose monitoring through a sensor placed under the skin every few days. User satisfaction was particularly high with the pump, but was more variable among those using continuous glucose monitoring.
Dr Alasdair Rankin, Diabetes UK Director of Research said, “Hypo unawareness and severe hypos are among the most feared complications of diabetes. We are very pleased to have supported this work, which show that the lives of people suffering from hypo unawareness can be improved through good education and support, regardless of how people take insulin and monitor their blood glucose.”
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CUH
PR & Communications
Adrian Ient, Media Relations Manager,
Communications Department, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ
Tel: 01223 274433 Email: adrian.ient@addenbrookes.nhs.uk
Newcastle University
Sam Wood
0191 208 7374, 07886 473 422 or e-mail sam.wood1@ncl.ac.uk
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‘Hypo’ attacks in Type 1 diabetes could be managed more effectively
23 May 2014
Cambridge scientists have been involved in a study that has found that more effective management could dramatically reduce the number of dangerous and potentially devastating hypoglycaemic events experienced by people with type 1 diabetes.