Impaired awareness of hypoglycaemia in women with type 1 diabetes in pregnancy: Hypoglycaemia fear, glycaemic and pregnancy outcomes

Bahrami, Jasmine, Tomlinson, George, Murphy, Helen R., Feig, Denice S. and , The CONCEPTT Collaborative Group (2022) Impaired awareness of hypoglycaemia in women with type 1 diabetes in pregnancy: Hypoglycaemia fear, glycaemic and pregnancy outcomes. Diabetic Medicine, 39 (5). ISSN 0742-3071

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Abstract

Aims: To examine maternal fear of hypoglycaemia, glycaemia and pregnancy outcomes in women with impaired and normal awareness of hypoglycaemia. Methods: A pre-planned sub-study of 214 pregnant women with type 1 diabetes who participated in the CONCEPTT trial. Participants completed hypoglycaemia fear surveys (HFS-II) at baseline. Logistic regression and Poisson regression analyses were used to obtain an adjusted estimate for the rate ratio relating awareness to the number of severe hypoglycaemic episodes, and for several neonatal outcomes in relation to the total HFS-II score. The role of continuous glucose monitoring (CGM) use was examined. Results: Overall, 30% of participants reported impaired awareness of hypoglycaemia (n = 64). Women with impaired awareness of hypoglycaemia had more episodes of severe hypoglycaemia (mean 0.44 vs. 0.08, p < 0.001) (12–34 weeks gestation) and scored higher on the HFS-II scale (43.7 vs. 36.0, p 0.008), indicating more fear of hypoglycaemia. They spent more time below range (CGM <3.5 mmol/L) and exhibited more glycaemic variability at 12 weeks gestation. Higher overall HFS-II scores were associated with a higher risk of maternal severe hypoglycaemia episodes (Rate Ratio 1.78, 95% CI 1.39–2.27). Women with impaired awareness of hypoglycaemia had less maternal weight gain but there were no differences in neonatal outcomes between women with impaired awareness of hypoglycaemia and normal hypoglycaemia awareness. Higher HFS-II scores were associated with more nephropathy (Odds Ratio 1.91, 95% CI 1.06–3.4). CGM use after 12 weeks was not associated with the number of episodes of severe hypoglycaemia (RR 0.75, 95% CI 0.49–1.15; p = 0.18). Conclusions: In pregnant women with type 1 diabetes, impaired awareness of hypoglycaemia is associated with more maternal severe hypoglycaemia episodes and more fear of hypoglycaemia. Having impaired awareness of hypoglycaemia and/or fear of hypoglycaemia should alert clinicians to this increased risk. Reassuringly, there was no increase in adverse neonatal outcomes.

Item Type: Article
Additional Information: CONCEPTT was funded by JDRF grant 17‐2011‐533 and grants under the JDRF Canadian Clinical Trial Network, a public–private partnership including JDRF and FedDev Ontario and supported by JDRF no. 80‐2010‐585. Medtronic supplied the CGM sensors and CGM systems at a reduced cost. HRM conducts independent research supported by the National Institute for Health Research (Career Development Fellowship CDF‐2013‐06‐035). GT, HRM, and DSF report grants from JDRF. HRM is supported by Tommy's charity. DSF reports grants from the Canadian Institutes of Health Research. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the UK Department of Health. The study sponsor/funder was not involved in the design of the study, the collection, analysis, interpretation of the data or in the writing of the report. Funding Information: DSF and HRM report grants from the Juvenile Diabetes Research Foundation during the conduct of the CONCEPTT study. DSF sits on the EXPECT Advisory Panel and reports personal fees from Novo Nordisk outside the submitted work. HRM reports personal fees from Novo Nordisk, Roche, and Medtronic, outside the submitted work. HRM sits on the Medtronic European Scientific Advisory Board. All remaining authors declare no competing interests.
Uncontrolled Keywords: endocrinology,internal medicine,endocrinology, diabetes and metabolism,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/1300/1310
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 17 Feb 2022 14:30
Last Modified: 06 May 2022 03:52
URI: https://ueaeprints.uea.ac.uk/id/eprint/83557
DOI: 10.1111/dme.14789

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