View of Hypoglycemia by People
with Diabetes and Family Members:
Second Diabetes Attitudes, Wishes
and Needs (DAWN2) Study
Introduction
● Given the unpleasant aspects of hypoglycemia and
the potentially life-threatening nature of severe
hypoglycemia, it is not surprising that many people
with T1DM or insulin-treated T2DM have a
significant fear of developing hypoglycemia.1
1. H
eather Stuckey
Penn State College of Medicine,
Hershey, PA, USA
2. S
anjay Kalra
Bharti Hospital and BRIDE,
Karnal, India
3. B
ernd Kulzer
Research Institute Diabetes,
Diabetes Zentrum Mergentheim,
Bad Mergentheim, Germany
4. R
achid Malek
CHU Sétif, Sétif, Algeria
5. N
eil Munro
University of Surrey,
Guildford, UK
6. M
ark Peyrot
Loyola University Maryland,
Baltimore, MD, USA
For the DAWN2 Study Group
Table 1. Psychosocial effects of hypoglycemia/total number of phrases about all effects of hypoglycemia (%).
People with diabetes
Family members
1
People with diabetes
taken to hospital due
to hypoglycemia
41/212
19%
33/109
30%
“After a day at the lake, my wife fell asleep on
the way home. When I went to wake her, she
would not respond. Ended up in emergency of
hospital. Very scary”
● Quantitative scales have been developed, such as
the Fear of Hypoglycemia Scale, to assess the
psychological impact of diabetes.2,3
“I went out of the house
feeling fine, then I collapsed
at the market and was taken
to the hospital. When my
family was informed, they
were overcome with fear”
2
62/212
29%
“I went to a bazaar 2 months
ago with the family. I fainted
and fell down. Then my son
gave me fruit”
28/109
26%
● Some qualitative work has been completed to
assess the worry of hypoglycemia on quality of life
for people with diabetes and their family members.4-8
Family members or
others who treat people
with diabetes exhibiting
hypoglycemia
“I have taught the children what to do should
their father become strange, and always be
ready with food and sugar/ candy”
3
Worry about symptoms
of hypoglycemia
43/212
20%
25/109
23%
“I’m so sorry about it and feel insecure at the
thought that it could happen again”
● Key objectives of the DAWN2 study were to gain a
better understanding of psychosocial needs,
successes, and wishes of people with diabetes and
those who care for them.
“I feel afraid to go to work
sometimes. It has happened
to me twice that I appeared
drunk and confused”
4
Family members did
not know what to do
or what was happening
N/A
15/109
14%
“My mother fell asleep and at the end of the
movie my dad and I tried to wake her up. She
woke up but she was completely confused,
didn’t know where she was ... my father and I
were very worried, we called the doctor right
away who told us she had very low blood
sugar and what to do in the future. Now we
are “used” to this but that first time was very
troubling!”
146/212
69%
101/109
93%
Aims
● The overall aim of the DAWN2 study was to assess
psychosocial outcomes in people with diabetes and
family members across countries for benchmarking.
● This poster reports the common global perceptions
of people with diabetes and family members about
the fears of hypoglycemia.
Methods
Study design
● DAWN2 is an international, interdisciplinary, multistakeholder study conducted in 17 countries across
four continents.
● The design and details of DAWN2 have been
reported previously.9 In this new report, qualitative
data were drawn from responses to open-ended
survey questions about the emotions surrounding
hypoglycemia.
● T he study was conducted in accordance with the
relevant ethical requirements in each country.
Participants
● The survey involved 8596 people with diabetes and
2057 family members from 17 countries.
● People with diabetes aged ≥18 years (1368 and
7228 with T1DM and T2DM, respectively); family
members included those living with people with
diabetes e.g., sibling, parent, significant other,
spouse.
Results
● The topic of worry about hypoglycemia yielded
212 codable phrases for people with diabetes, and
109 for family members. Emergent coding with
input from multinational collaborators generated
the coding categories.
● Core themes were found in these codes, which
indicated concerns about hypoglycemia for both
people with diabetes and family members:
(1) p
eople with diabetes taken to hospital due
to hypoglycemia.
(2) f amily members or others who treat people
with diabetes exhibiting hypoglycemia; and
(3) people with diabetes worry about hypoglycemia;
(4) Family members reported being unsure of what
to do or what was happening during a
hypoglycemic event – such as the spouse who
said: “I was afraid he was having a stroke,
when it was hypo” (Table 1).
TOTAL
● P eople with diabetes, on the other hand, generally
reported knowing what to do to control their
blood sugar or attributing a hypoglycemic event to
being the cause of losing control of their vehicle,
passing out, or becoming dizzy.
● T he table represents the themes of both the people
with diabetes and family members regarding the
psychosocial effects of hypoglycemia.
● E xamples of codes that were not coded as
psychosocial include: “hypoglycemia was due to
exercise”, or “hypoglycemia was due to not eating
on time”, or “hypoglycemia while on vacation or
traveling”.
● T he numbers in Table 1 represent the total number
of codes related to hypoglycemia/psychosocial
codes for hypoglycemia, then expressed as a
percentage.
● B
oth family members’ and people with diabetes’
responses regarding hypoglycemia were
psychosocial in nature; however, more family
members’ responses to hypoglycemia were
psychosocial (93%) compared to people with
diabetes (69%).
Conclusions
● W
ith agreement to previous literature, the fear
of hypoglycemia remains a fear or concern for
people with diabetes and family members.
Those living with people with diabetes should
be educated in the early stages of diabetes to
manage hypoglycemia.
● O
ne primary conclusion from this research is
that family members in particular may benefit
from early education about the symptoms of,
and a plan of action for, hypoglycemia to
alleviate initial anxiety and lack of knowledge/
awareness.
References
1. Wild D, et al. Patient Educ Couns 2007;68:10–5.
2. Gonder-Frederick LA, et al. Diabetes Care 2011;34:801–6.
3. Cox DJ, et al. Diabetes Care 1987;10:617–21.
4. L awton J, et al. Diabetes Care 2013, Aug 29 [Epub ahead of print].
5. Lawton J, et al. Diabetes Res Clin Pract 2012;98:236–42.
6. Rankin D, et al. BMC Public Health 2012;12:652.
7. Rankin D, et al. Diabet Med 2012;29:1079–84.
8. Jenkins N, et al. Diabet Med 2011;28:543–8.
9. Peyrot M, et al. Diabetes Res Clin Pract 2013;99:174–84.
Abbreviations
● A
nother difference was that when asked about the
challenges of diabetes, family members reported
their first instance of dealing with a hypoglycemic
event (and not feeling prepared), whereas people
with diabetes reported recurring episodes.
DAWN, Diabetes Attitudes, Wishes and Needs (study); IAPO,
International Alliance of Patients’ Organizations; IDF, International
Diabetes Federation; IPPC, International Publication Planning
Committee; T1DM, type 1 diabetes mellitus; T2DM, type 2
diabetes mellitus.
● F urthermore, people with diabetes generally listed
reasons as to why their blood glucose became low,
whereas family members did not. Examples
included exercise (“I walked too much, and I asked
for a Coke”) or skipping a meal (“If I don’t eat on
time, I feel giddiness and cannot withstand it”).
The DAWN2 study is a global partnership of established
organizations, including the IDF, the IAPO and the Steno Diabetes
Center, and Novo Nordisk. DAWN2 study group: R. Malek; J. Wens;
J.E. Salles; K. Kovacs Burns; M. Vallis; X. Guo; I. Willaing; G. Reach;
N. Hermanns; B. Kulzer; S. Kalra; A. Nicolucci; M. Comaschi; H. Ishii;
M. Escalante; F. Pouwer; A. Kokoszka; A. Mayorov; E. Menéndez Torre;
I. Tarkun; M. Davies; R.I.G. Holt; A. Forbes; N. Munro; M. Peyrot; with
S.E. Skovlund and C. Mullan-Jensen (Novo Nordisk).
● T he analyses of challenges of hypoglycemic
events expressed through narratives capture the
full range of how both people with diabetes and
family members experience hypoglycemic events,
the latter being more focused on the causes
and remedies.
Data access: For more information contact [email protected].
Acknowledgments
Funding: Novo Nordisk A/S funded the DAWN2 study, including
planning and designing in collaboration with national, regional and
global partners. Novo Nordisk funded typesetting support by
Bioscript Medical Ltd and independent data collection by
Harris Interactive. Data analysis and publication preparation were
performed by members of the DAWN2 IPPC and authors. DAWN and
DAWN2 are registered trademarks of Novo Nordisk.