INTRODUCTION
The Diabetes Control and Complications trial (DCCT) has clearly
demonstrated that in people with Type 1 Diabetes (T1D), good glycaemic
control leads to decreased risk of diabetes-related
complications1. However, hypoglycaemia and impaired
awareness of hypoglycaemia (IAH) are important barriers to optimization
of glycaemic control.
Hypoglycaemia is defined as an episode of abnormally low plasma glucose
that exposes the individual to potential harm2.
Hypoglycaemia can be classified into three levels: a hypoglycaemia alert
value (glucose =< 3.9 mmol/L), clinically significant
hypoglycaemia (glucose < 3 mmol/L) and severe hypoglycaemia,
which is hypoglycaemia associated with severe cognitive impairment
requiring external assistance for recovery3. Impaired
awareness of hypoglycaemia (IAH) is defined as a diminished ability to
perceive the onset of hypoglycaemia4. IAH is an
important clinical problem in people with T1D which leads to increased
risk of severe hypoglycaemia (SH), increased morbidity and mortality and
decreased quality of life5–9.
Despite this, there have been no
prior studies on IAH done in T1D patients in Singapore. We aimed to
assess the prevalence of IAH in Singapore, including its frequency,
impact and association with diabetes self-management practices, in T1D
patients. We also aimed to evaluate the use of the Gold and Clarke
scores, both of which can be routinely administered in clinical
practice, for assessment of IAH.