Development and Validation of a Questionnaire Evaluating Impaired Hypoglycemia Awareness among Adult Filipino Patients with Type 2 Diabetes Mellitus

Authors

Keywords:

diabetes mellitus, hypoglycemia, questionnaire

Abstract

Introduction. Hazards of hypoglycemia include accidents, cardiovascular events, neurologic damage, and impaired hypoglycemia awareness (IHA) which presents as inability to perceive and respond to hypoglycemic warning symptoms.

Objective. This study aimed to develop the first questionnaire evaluating IHA adapted from Clarke Hypoglycemia Index (CHI) and validated among adult Filipino patients with Type 2 Diabetes Mellitus (T2DM).

Methodology. A questionnaire development study was conducted involving CHI linguistic translation, its modification through literature review and focus group discussions, panel synthesis, and content validity. A cross-sectional analytic study followed by administration of the questionnaire to 117 adult Filipinos with T2DM, advanced age, long-standing T2DM, insulin or sulfonylurea, polypharmacy, comorbidities and/or prior hypoglycemia. There were 9 participants in pilot testing, 69 in criterion validity against continuous glucose monitoring (CGM), and 108 in construct validity.

Results. IHA domains in the concept map included Elusive Euglycemia Model, Developmental Model, and Cognitive Model. The Filipino-CHI formulated had 8 questions with content validity scores ranging from 87.5-93.75%. Owing to brevity, its internal consistency Cronbach’s alpha was 0.45. Criterion validity against CGM yielded 21 patients with biochemical hypoglycemic events, of which 2 had clinical hypoglycemic events and 19 were positive monitor-identified IHA. A questionnaire IHA cutoff score of ≥4 had sensitivity of 89.47%, and area under the curve of 0.55.

Conclusion. An 8-item questionnaire evaluating IHA among adult Filipino T2DM patients was developed and validated.

Downloads

Download data is not yet available.

Author Biographies

Uzziel de Mesa, University of the Philippines- Philippine General Hospital

Fellow, Section of Endocrinology, Department of Medicine, University of the Philippines- Philippine General Hospital

Ma. Cecile Anonuevo-Cruz, University of the Philippines-Philippine General Hospital

Consultant, Section of Endocrinology, Department of Medicine, University of the Philippines-Philippine General Hospital

Nemencio Nicodemus Jr., University of the Philippines-Philippine General Hospital

Consultant and Professor, Department of Medicine, University of the Philippines-Philippine General Hospital

Nikolai Reyes, University of the Philippines-Philippine General Hospital

Resident, Department of Neurosciences, University of the Philippines-Philippine General Hospital

References

Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet.1998;352(9131):837-53. PMID: 9742976.

De Galan BE, Schouwenberg BJ, Tack CJ, Smits P. Pathophysiology and management of recurrent hypoglycaemia and hypoglycaemia unawareness in diabetes. Neth J Med 2006;64(8):269-79. PMID: 16990690.

Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med 2013;369(4):362-72. PMID: 23883381. https://doi.org/10.1056/NEJMra1215228.

Ortiz-Alonso FJ, Galecki A, Herman WH, Smith MJ, Jacquez JA, Halter JB. Hypoglycemia counterregulation in elderly humans: Relationship to glucose levels. Am J Physiol 1994;267(4 Pt 1):E497–506. PMID: 7943297.

Dagogo-Jack SE, Craft S, Cryer PE, Hypoglycemia-associated autonomic failure in insulin-dependent diabetes mellitus. Recent antecedent hypoglycemia reduces autonomic responses to, symptoms of, and defnsse against subsewuent hypoglycemia. J Clin Invest. 1993;91(3):819-28. PMCID: PMC288033. https://doi.org/10.1172/JCI116302.

Wiegers EC, Rooijackers HM, Tack CJ, Heerschap A, de Galan BE, van der Graaf M. Brain lactate concentration falls in response to hypoglycemia in patients with type 1 diabetes and impaired awareness of hypoglycemia, Diabetes. 2016;65(6):1601-5. PMID: 26993070. https://doi.org/10.2337/db16-0068.

Mangia S, Tesfaye N, De Martino F, et al. Hypoglycemia induced increases in thalamic cerebral blood flow are blunted in subjects with type 1 diabets and hypoglycemia unawareness. J Cerebral Blood Flow Metab. 2012;32(11):2084-90. PMCID: PMC3494000. https://doi.org/10.1038/jcbfm.2012.117.

Seltzer HS. Drug-induced hypoglycemia. A review of 1418 cases. Endocrinol Metab Clin North Am. 1989;18(1):163-83. PMID: 2645125.

American Diabetes Association. Standards of Medical Care in Diabetes-2017. Diabetes Care. 2017;40(Suppl 1):S1-132. http://www.epi.uff.br/wp-content/uploads/2013/10/dc_40_s1_final.pdf.

Pedersen-Bjergaard U, Pramming S, Thorsteinsson B. Recall of severe hypoglycemia and self-estimated state of awareness in type 1 diabetes. Diabetes Metab Res Rev. 2003;19(3):232-40. PMID: 12789657. https://doi.org/10.1002/dmrr.377.

Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type 1 diabetes with impaired awareness of hypoglycemia. Diabetes Care. 1994;17(7):697-703. PMID: 7924780.

Clarke WL, Cox DJ, Gonder-Frederick LA, Julian D, Schlundt D, Polonsky W. Reduced awareness of hypoglycemia in adults with IDDM. Diabetes Care. 1995;18(4):517-22. PMID: 7497862.

Pedersen-Bjergaard U, Pramming S, Heller SR, et al. Severe hypoglycemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection. Diabetes Metab Res Rev. 2004;20(6):479-86. PMID: 15386817. https://doi.org/10.1002/dmrr.482.

Speight, J, Barendse SM, Singh H, et al. Characterizing problematic hypoglycemia: Iterative design and preliminary psychometric validation of Hypoglycemia Awareness Questionnaire (HypoA-Q). Diabet Med. 2016;33(3):376-85. PMID: 26042777. https://doi.org/10.1111/dme.12824.

Geddes J, Wright RJ, Zammit NN, Deary IJ, Frier BM. An evaluation of methods of assessing impaired awareness of hypoglycemia in type 1 diabetes. Diabetes Care. 2007;30(7):1868-70.

Jansà M, Quirós C, Giménez M, Vidal M, Galindo M, Conget I. Análisis psicométrico de las versiones en lengua castellana y catalana de un cuestionario de percepción de la hipoglucemia. Medicina Clínica. 2015;144(10): 440-4. https://doi.org/10.1016/j.medcli.2013.11.036.

How to conduct a focus group [Online], 2014. Available in https://assessment.trinity.duke.edu/documents/How_to_Conduct_a_Focus_Group.pdf. Accessed January 26, 2016.

Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform. 2014;48:193-204. PMID: 24582925. https://doi.org/10.1016/j.jbi.2014.02.013.

Nunally JC. Book review: Pychometric theory: 3rd ed. In Nunally, JC, Bernstein IH. The role of factor analysis. New York: McGraw-Hill, 1994.

Measuring learning & performance: A primer. Chapter 3 Psychometrics: Reliability & validity [Online] 2014. Available in http://charlesdennishale.org/Measuring-Learning-and-Performance/3-MLP-Psychometrics-Reliability-and-Validity-3.1.pdf. Accessed August 22, 2017.

Cryer P. Hypoglycemia. In: Melmed, S; Polonsky K, Larsen P, et al. William’s Textbook of Endocrinology, 13th ed. Elsevier, 2016.

Tavakol M, Dennik R. Making sense of Cronbach’s alpha. Int J Med Educ. 2011;2:53-5. PMCID: PMC4205511. https://doi.org/10.5116/ijme.4dfb.8dfd.

Jimeno CA, Sobrepeña LM, Mirasol RC. Diab Care 2008: Survey on glycaemic control and the status of diabetes care and complications among patients with type 2 diabetes mellitus in the Philippines. Philipp J Intern Med. 2012;50(1):15-22.

Published

2017-10-14

How to Cite

de Mesa, U., Anonuevo-Cruz, M. C., Nicodemus Jr., N., & Reyes, N. (2017). Development and Validation of a Questionnaire Evaluating Impaired Hypoglycemia Awareness among Adult Filipino Patients with Type 2 Diabetes Mellitus. Journal of the ASEAN Federation of Endocrine Societies, 32(2), 158. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/423

Issue

Section

Original Articles

Similar Articles

1 2 > >> 

You may also start an advanced similarity search for this article.