Concerns about hypoglycemia in India: Results from second diabetes attitudes wishes and needs study.

Introduction: The second diabetes attitudes wishes and needs (DAWN2) study is a multinational observational study, which took place in 17 countries including India, and aimed to provide a holistic assessment of diabetes care and management among people with diabetes (PWD), family members (FM), and healthcare professionals (HCPs). It explored potential drivers leading to active management of diabetes and assessed barriers to the same. Hypoglycemia is an inevitable complication and barrier to tight glycemic control in patients with diabetes. Objectives: This abstract describes the frequency and type of hypoglycemic episodes among PWD, and concerns regarding hypoglycemia among PWD, FM and HCP, in the Indian cohort of DAWN2. Materials and Methods: DAWN used a cross-sectional study design to collect different aspects of diabetes care. Information about hypoglycemia in DAWN2 study was analyzed from randomly chosen Indian subjects, and collected by questionnaires from face to face interviews with PWD, HCP and FM. Descriptive statistics were used to report the data. Results: All qualified PWD were analyzed according to these subgroups: (T1 [type 1 diabetes]: n = 78; T2 non-med [type 2 diabetes not on medication]: n = 100; T2 non-insulin med [type 2 diabetes on medications other than insulin]: n = 170 and T2 insulin med [type 2 diabetes on insulin with or without medication]: n = 152) were included in the analysis. Among persons with T1 diabetes, 41 % reported self-treated episodes of hypoglycemia in a frequency of less than 1 per month compared, to 49% with T2 diabetes on insulin. 29% people with T1 diabetes reported similar self-treated episodes several types per month (or once a week) compared to 17% in T2 diabetes on insulin. The mean frequency of severe hypoglycemia in last 12 months among these PWD was as follows: T1 diabetes: 2.2, T2 non-med: 2.6, T2 non-insulin med: 2.4 and T2 insulin med: 3.2. Roughly one-quarter of T1 PWD (26%) and one-third of T2 insulin med PWD (32%) reported that they could often or always tell by their symptoms that their blood sugar is low. About one-quarter of FMs (22-26%) reported that the person they live with had low blood sugar symptoms at least once a week or several times a month. FMs insulin med indicated that the person they live with has had on average 2.3 severe low blood sugar episodes in the past 12 months. One-third of FMs insulin med (32%) were also able to often or always recognize by the symptoms that the person they live with is having a low blood sugar episode. More than one-quarter of FMs felt they have to help with low blood sugar events at least once a week or several times a month (27-28%) whereas, between 25% and 32% of FMs only feel that they are at the best somewhat confident of dealing with these type episodes. Conclusion: Around one-third of Indians with type 1 diabetes experienced self-reported episodes of hypoglycemia several times a month (or more than once a week). Only a third of FM of persons with diabetes could recognize symptoms of hypoglycemia. Only a third of FM of patients with diabetes felt they were only somewhat confident of dealing with hypoglycemic episodes. This highlights a major lacuna in existing insulin therapy, in diabetes education of both PWD and FM, in hypoglycemia awareness training, and in self-management of hypoglycemia in India. Necessary skills need to be imparted to all stake holders in diabetes care. [ABSTRACT FROM AUTHOR]