What does this article add?
This is the first study on IAH in T1D patients in Singapore, with no prior reported studies in the literature. Most of the prior studies on IAH have been performed in Caucasian, rather than Asian populations. Thus, our study would provide useful information for clinicians practising in Asian countries where Diabetes Mellitus is a burgeoning problem.
Our study illustrates the utility of the Gold and Clarke scores, simple clinical tools which can be administered in an outpatient setting, to screen for IAH in patients with T1D. We assess the association of both scores with the important clinical outcome of severe hypoglycaemia, and compare the performance of both scores with each other. Our study is the first to compare the performance of both the Gold and Clarke scores with the HYPO score – a composite hypoglycaemia score based on the frequency, severity and degree of unawareness of hypoglycaemia. As calculation of the HYPO score is highly laborious and difficult to do in routine clinical practice, our findings confirm that a simple questionnaire-based tool is comparable with a far more rigorous method for assessment of hypoglycaemia.
Our study is also novel in that it provides an analysis of the specific content and delivery of education which is most efficacious in reducing IAH in patients with T1D. For example, group education, education on self-adjustment of insulin doses and blood glucose targets are particularly useful.
In summary, our study provides several clinical pearls of practical significance which would be useful for all clinicians managing patients with T1D.