Associations between impaired awareness of hypoglycaemia and mental health in insulin‐treated type 2 and type 1 diabetes in the Hypo‐ METRICS study

AIMS: The mental health impact of impaired awareness of hypoglycaemia (IAH) in people with type 2 diabetes (T2D) is not known. We explored this in people with insulin-treated T2D and type 1 diabetes (T1D). METHODS: Hypo-METRICS was a 10-week cross-sectional observation of hypoglycaemia experience, collecting data on glucose and activity. Participants (325 insulin-treated T2D, 277 T1D) completed questionnaires scoring depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and fear of hypoglycaemia (HFS-II [worry]) at baseline. IAH was defined as a Gold score ≥4. Relationships between IAH and mental health scores were explored using unadjusted and adjusted generalised linear regression analyses. Age, sex, race, diabetes duration, level of education, employment status, continuous glucose monitoring (CGM) use, hypoglycaemia, use of anti-depressants and use of anti-anxiety medications were covariates in the adjusted regression. RESULTS: In unadjusted regression in insulin-treated T2D, IAH was associated with higher PHQ-9 (6.4% [1.5%-11.3%]; p = 0.011), GAD-7 (7.6% [2.1%-13%]; p = 0.006) and HFS-II (worry) (7.4% [2.8%-12%]; p = 0.002) scores, with no differences in PAID (p = 0.655). After adjustment, IAH was associated with higher HFS-II (worry) (5.3% [0.3%-10.6%]; p = 0.048) only. In T1D, IAH was associated with higher PHQ-9 (6.2% [1.3%-10.8%]; p = 0.012), GAD-7 (6.1% [0.1%-12.2%]; p = 0.046) and HFS-II (worry) (6.1% [0.06%-11.5%]; p = 0.029) scores, but not PAID (p = 0.654), all unadjusted. These relationships remained after adjustment, which also showed higher PAID (8.43% [2.62%-14.24%]; p = 0.005). CONCLUSION: Our data demonstrated associations between IAH and a greater mental health burden in both insulin-treated T2D and T1D. Addressing these mental health challenges should be an important part of the holistic care of people with IAH and insulin-treated diabetes.