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.

Background The impact of lockdown measures can be widespread, affecting both clinical and psychosocial aspects of health. This study aims to assess changes in health services access, diabetes self-care, behavioral and psychological impact of COVID-19 and partial lockdown in Singapore. Methods We conducted a cross-sectional online survey amongst people with diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression analyses were performed for each DHP-18 subscale (Psychological Distress, Disinhibited Eating and Barriers to Activity) as dependent variables in separate models. Results Among 301 respondents, 45.2% were women, majority were ethnic Chinese (67.1%), aged 40 to 49 years (24.2%), have Type 2 diabetes (68.4%) and on oral medications (42.2%). During the lockdown, nearly all respondents were able to obtain their medications, supplies (94%) and contact their doctors (97%) when needed. Respondents reported less physical activity (38%), checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of mental health conditions (β=11.44, p= 0.017), diabetes-related comorbidities (β= 3.98, p= 0.001) and Indian ethnicity (β= 7.73, p= 0.018) were significantly associated with higher psychological distress. Comorbidities were associated with higher disinhibited eating (β= 2.71, p= 0.007) while mental health condition was associated with greater barriers to activities (β= 9.63, p= 0.033). Conclusion Health services access were minimally affected but COVID-19 and lockdown had mixed impact on self-care and management behaviors. Greater clinical care and attention should be provided to people with diabetes with greater number of comorbidities and previous mental health disorders during the pandemic and lockdown.