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A Study on Impaired Awareness of Hypoglycaemia in Type 1 Diabetes Patients in a Tertiary Care Centre in Singapore

Background: This study aims to establish the frequency of severe
hypoglycaemia and impaired awareness of hypoglycaemia (IAH) in Type 1
diabetes (T1D) patients in Singapore. We evaluate the utility of the
Gold and Clarke scores as screening tools for IAH, and assess the
effects of diabetes self-management practices and education in reducing
IAH. Methods: This is an observational study of 131 subjects with T1D at
a regional hospital, which included review of medical records,
self-administered questionnaires and a prospective 4 week period of
self-monitoring of blood glucose (SMBG). Results: The frequency of
clinically significant hypoglycaemia (blood glucose < 3
mmol/L) during the 4 week period of SMBG was 38.8%, while the frequency
of severe hypoglycaemia over the last one year was 22.5%. Based on the
Gold score and Clarke score, 28.3% and 24.6% of subjects respectively
had IAH. The Clarke score was associated with increased frequency of
clinically significant hypoglycaemia, severe hypoglycaemia and
hospitalizations for hypoglycaemia. Prior group education, education
from a dietitian and education on blood glucose targets were associated
with lower Clarke scores, while adjusting insulin doses for blood
glucose using an insulin sensitivity factor was associated with lower
Gold and Clarke scores. Conclusion: IAH is common in T1D patients in
Singapore and is associated with increased risk of severe hypoglycaemia.
The Gold and Clarke scores are simple tools which can be routinely
administered to identify patients with IAH who might benefit from
specific interventions, particularly structured diabetes education, to
decrease IAH and its complications.