Smith et al. (1) have demonstrated that people with type 1 diabetes who have impaired awareness of hypoglycemia (IAH), diagnosed on clinical history alone, are less likely to adhere to therapeutic decisions. This finding is of clinical importance as the syndrome of IAH is often very difficult to manage, and the reluctance of affected patients to comply with recommended therapeutic measures compounds the problem of attempting avoidance of severe hypoglycemia.
Two earlier studies also identified patients' attitudes and behavioral responses that are consistent with this observation. In a 12-month prospective study of the incidence of severe hypoglycemia in 60 patients with type 1 diabetes (29 with IAH) (2), the patients with IAH failed to modify their behavior to avoid hypoglycemia despite recording a significantly greater fear of hypoglycemia on the Hypoglycemic Fear Survey (3). In a larger study of 305 patients with type 1 diabetes (111 with IAH) (4), although increased worry of hypoglycemia was exhibited by the patients with IAH, once again they made no attempt to modify their behavior to prevent, avoid, or correct hypoglycemia with any greater frequency or vigilance than the patients who had normal awareness. It is unclear whether people who develop IAH have a particular personality type or whether their behavior and approach to self-management are influenced by exposure to recurrent severe hypoglycemia. The role of personality on the behavioral responses to hypoglycemia merits further investigation, and people with IAH may require psychological counseling to help them modify the management of their diabetes.
Acknowledgments
No potential conflicts of interest relevant to this article were reported.
