Despite advances in diabetes therapies and technologies since the discovery of insulin 100 years ago, hypoglycaemia (low blood glucose) remains a common side effect of intensive insulin therapy and a major concern for adults with type 1 diabetes mellitus (T1DM). While past research has shown that hypoglycaemia is associated with several adverse consequences, the impact of hypoglycaemia on quality of life (QoL) among adults with T1DM is not yet well understood. In addition, few studies have examined support needs relating to hypoglycaemia, specifically. The aim of this program of research was to investigate the impact of hypoglycaemia on QoL and support needs relating to hypoglycaemia among adults with T1DM.
Research questions were investigated using a mixed-methods approach. Three studies were conducted and are presented in four papers. Study 1 involved a systematic review of current evidence regarding the associations between hypoglycaemia and QoL-related outcomes. Study 2 involved a web-based qualitative study exploring the impact of hypoglycaemia on domains of life that adults with T1DM nominated themselves as important to their overall QoL. In addition, Study 2 explored support needs relating to hypoglycaemia. Study 3 involved a web-based quantitative survey examining the impact of hypoglycaemia on QoL among adults with T1DM.
Across the three studies conducted, the findings show that hypoglycaemia negatively impacts on several domains of QoL that are important to adults with T1DM, including relationships, work/studies, leisure and physical activity, everyday life, sleep, sex life, physical health, dietary freedom, mental health/emotional well-being, the ability to keep fit/be active, independence, and the ability to be spontaneous. Important domains of QoL were affected by severe hypoglycaemia, as well as self-treated hypoglycaemia and impaired awareness of hypoglycaemia (IAH). In addition, QoL was negatively impacted by hypoglycaemic episodes as well as the perceived risk of hypoglycaemia (i.e., fear of hypoglycaemia and efforts to prevent hypoglycaemia). Finally, this thesis found that adults with T1DM have unmet support needs relating to hypoglycaemia, including needs for more structured clinical support from healthcare professionals, and practical and emotional support from family members, friends, colleagues, and the public. Prospective research in unselected populations is needed to corroborate these findings.
This program of research addressed key gaps in the current understanding of hypoglycaemia and QoL among adults with T1DM. Several implications for research and clinical practice were highlighted. This thesis applied novel methods that could be implemented in future studies and could have applications in clinical care. The findings suggest that healthcare professionals need to ask adults with T1DM about experiences of hypoglycaemia, including severe episodes, self-treated episodes, and IAH. In addition, healthcare professionals need to ask adults with T1DM how domains of QoL that are important to them are affected by hypoglycaemic episodes and the perceived risk of hypoglycaemia. These discussions should occur periodically and should not be limited to individuals who experience frequent hypoglycaemia. Finally, healthcare professionals need to identify the support needs of adults with T1DM. Together with the person with diabetes, targeted strategies aimed at reducing the burden of hypoglycaemia could be discussed. This thesis highlights that there is no one-size-fits-all approach to addressing the burden of hypoglycaemia and that person-centered care involving tailored intervention is preferred by adults with T1DM.
Print copy of the full thesis is restricted to reference use in the Library.