Relationship between Hypoglycemia Awareness Status on Clarke/Gold Methods and Counterregulatory Response to Hypoglycemia

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Context: Impaired awareness of hypoglycemia (IAH) is characterized by the diminished ability to perceive symptoms of hypoglycemia. Gold and Clark questionnaires are commonly used to identify patients with IAH. The relationship between IAH status on questionnaires and a person's symptom and epinephrine responses to hypoglycemia are not well understood. Objective: We aimed to examine the relationship between hypoglycemia awareness status on Clarke and Gold questionnaires with both hormonal and symptomatic responses to experimental hypoglycemia. Methods: In this university medical center study, we examined data from 78 subjects with type 1 diabetes (T1D) who completed both questionnaires and underwent a hyperinsulinemic hypoglycemic clamp (target glucose 50 mg/dL). Results: Clarke and Gold scores were highly correlated with one another (r = 0.82) and each had a moderate negative relationship with epinephrine (Clarke: r = -0.51, Gold: r = -0.50) and total symptom response (Clarke: r = -0.59, Gold: r = -0.57). However, 32% of the subjects were classified inconsistently by Clark vs Gold. A clustering analysis was done to examine how disagreement between the 2 questionnaires on IAH classification relates to epinephrine and symptoms responses during hypoglycemia. Subjects who had partial loss of symptoms or of epinephrine response were more likely to be classified inconsistently. Conclusion: Our results show that IAH classification may be discordant between Clark and Gold questionnaires and that hypoglycemia awareness status on Clarke and Gold questionnaires poorly predicts hormonal and symptomatic responses to hypoglycemia in subjects with T1D and moderate blunting of symptoms or epinephrine.

Original languageEnglish (US)
Article numberbvac107
JournalJournal of the Endocrine Society
Volume6
Issue number9
DOIs
StatePublished - Sep 1 2022

Bibliographical note

Funding Information:
This work was supported by grant support from CTSI KL2TR000113 to A.M. and S.M., R01 NS035192 (E.R.S., G.Ö.), National Institutes of Health P41 EB015894 and P41 EB027061, P30 NS076408, DK 20593, and DK020593, R56 DK099137 (S.M.) and R01 DK099137 (S.M.).

Publisher Copyright:
© 2022 The Author(s).

Keywords

  • Clarke questionnaires
  • Gold questionnaires
  • hypoglycemia
  • hypoglycemia unawareness
  • impaired awareness of hypoglycemia
  • type 1 diabetes

Fingerprint

Dive into the research topics of 'Relationship between Hypoglycemia Awareness Status on Clarke/Gold Methods and Counterregulatory Response to Hypoglycemia'. Together they form a unique fingerprint.

Cite this