Hypoglycaemia: poorly recognised by patients with type I diabetes

Clinical bottom line (level 4)

  1. In patients with insulin-dependent diabetes mellitus, hypoglycaemia was recognised with a sensitivity of only 55%, by them.
  2. 'Accuracy' of overall self-assessments was poor; 10% of assessments were dangerous
Fritsche et al: Diabetes Research and Clinical Practice 1998; 40: 129-135
Expires August 2003

The study

Setting: teaching hospital in Germany

33 patients (aged ?, 52% male) insulin-dependent diabetes mellitus (IDDM) patients who had undergone a training program to intensify insulin usage

Excluded if
  • inability to attend or comprehend the teaching program
  • had not completed a constant blood glucose diary (39% of the initial study population excluded)


    • training to recognise symptoms of hypoglycaemia
    Independent blinded reference standard, applied in all patients from a non-consecutive inappropriate spectrum.
    Reference standard:
    • fingerprick blood sugar measurements
    Diagnostic test: patient perception of blood sugar level

    The evidence

    pre-test probability of hypoglycaemia (BM<4): 55%, (95% CI: 45% to 65%)

    diagnostic test number of patients sensitivity for
    hypoglycaemia
    (95% CI)    		 LR+ LR-
    self-perceived hypoglycaemia 6 55%
    (45% to 65%)
    total

    • 'accuracy' of self-perception also assessed: overall, 10% of estimates were 'dangerously' inaccurate

    Comments

    1. Patients were highly selected; only those who completed BM diaries were assessed
    2. 'Accuracy' reports of blood sugar estimations difficult to convert into useful clinical measures of diagnostic ability
    3. Study also looked at effect of education program as a 'before/after' approach

    Citation

    1. Fritsche A, Stumvoll M, Renn W, et al: Diabetes teaching program improves glycaemic control and preserves perception of hypoglycemia. Diabetes Research and Clinical Practice 1998; 40: 129-135
    Contributor: Bob Phillips and Clare Wotton, August 1999
    Reviewer: Santiago Alvarez Montero

    Clinical Question.
    Patient hypoglycaemic, diabetic
    Intervention or Exposure symptoms of hypoglycaemia
    Outcome biochemical hypoglycaemia