'Hyperglycemia aversiveness': Investigating an overlooked problem among adults with type 1 diabetes

摘要

Aims: To investigate the problem of adults with type 1 diabetes (T1D) who purposefully keep their glucose levels low, and to explore contributors to, and possible impact of, this potentially dangerous phenomenon. Methods: We developed three self-report items as a means to identify individuals who endorse a consistent pref-erence for hypoglycemia over hyperglycemia ("Hyperglycemia Aversives"). In a large T1D survey (n = 219), val-idated measures of well-being, emotional distress and hypoglycemic awareness, and glycemic metrics derived from the past 14-day period, were used to examine whether Hyperglycemia Aversives could be characterized as a distinct group. Results: Hyperglycemia Aversives comprised 16.4 of the sample. This unique group demonstrated significantly higher mean TIR (71.6 vs. 63.6) and TBR (5.1 vs. 2.2), lower mean TAR > 250 mg/dL (6.0 vs. 10.1), and higher rates of impaired hypoglycemic awareness and recurrent severe hypoglycemia episodes than the remain-ing study sample ("Non-Aversives") (all ps < 0.01). The two groups did not demonstrate significant differences on psychosocial outcomes. Conclusions: We identified a group of T1D adults reporting a consistent preference for hypoglycemia over hyper-glycemia. These individuals achieve significantly greater TIR and less TAR, but at the cost of greater TBR and more frequent severe hypoglycemia episodes. (c) 2021 Elsevier Inc. All rights reserved.