Fresh insights from the HypoCOMPaSS trial suggest they can
By Amy Johnson
For people living with type 1 diabetes (T1D), hypoglycaemia (also known as a hypo or low blood glucose) is a common side effect of insulin. Hypos occur when blood glucose falls below the target range. People can experience a range of symptoms. For example, weakness, dizziness, shaking and reduced focus. About 25-40% of adults with T1D have lost (some) awareness of their hypo symptoms. This can increase the risk of a hypo becoming severe by 60%. A severe hypo is when the person with T1D needs help from another person to recover. Fear of severe hypos leads some people to keep their glucose levels in a higher range to avoid hypos. But, doing this over a long period of time increases the risk of long-term complications. So, we need better strategies for avoiding severe hypos.
The aim of the HypoCOMPaSS trial was examine how to reduce severe hypos in adults with T1D who had lost awareness of their hypo symptoms. The study involved 96 adults. Almost two-thirds were women. On average, they had lived with T1D for 29 years. At baseline, doctors checked their insulin doses and adjusted them if needed. All took part in a brief learning program focusing on how to reduce risk of severe hypos and hypos while asleep. This led to fewer severe hypos, better awareness of symptoms, and higher treatment satisfaction. These results were sustained over 24 weeks. The improvements were similar across all groups, regardless of whether they used insulin injections or a pump; or whether they used finger-prick or continuous glucose monitoring.
A recent study [1]led by ACBRD Research Fellow Dr Uffe Søholm [2] and colleagues analysed more data from the HypoCOMPaSS trial. They used the novel Hypoglycaemia Burden Questionnaire. It measures the frequency, severity, burden, and usefulness of symptoms. Participants completed it at baseline and 24 weeks.
What did they find?
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- People with T1D experience many hypo symptoms: 97% reported at least one symptom. On average, they reported 10 out of a list of 20 symptoms. These included physical symptoms (e.g. sweating and shaking) and cognitive symptoms (e.g. confusion and trouble focusing).
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- Between 17% and 85% were not aware that their symptoms may be due to their hypos.
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- Symptoms can change over time: After 24 weeks, participants reported fewer hypo symptoms. There was an increase in physical symptoms (e.g. warmth, nausea, and headache), which often precede cognitive symptoms. This suggests that people became attuned to their early warning signs.
Some important implications of these findings are:
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- Misreading symptoms: People with impaired awareness of hypos often get used to living with subtle symptoms, and don’t link them to low blood glucose.
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- Improved symptom awareness: Education helps people see symptoms as useful warning signs rather than as a burden. This improves awareness of hypo symptoms previously missed.
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- Early detection and care: Seeing symptoms as useful warning signs helps detect hypos early. This leads to prompt self-care, and less time spent with low glucose. This shows that pairing education with medical care is key to better T1D management.
Check out our previous blogs [3] to learn more about hypos.
Reference:
Søholm, U., Holmes-Truscott, E., Broadley, M., Amiel, S. A., Hendrieckx, C., Choudhary, P., Pouwer, F., Shaw, J. A. M., & Speight, J. (2024). Hypoglycaemia symptom frequency, severity, burden, and utility among adults with type 1 diabetes and impaired awareness of hypoglycaemia: Baseline and 24-week findings from the HypoCOMPaSS study. Diabetic Medicine : A Journal of the British Diabetic Association, 41(1), e15231. https://doi.org/10.1111/dme.15231 [4]