Type 1 diabetes are less likely to recognize symptoms of impending hypoglycemia if they have concurrent anxiety and depression, suggests a study published in the journal Diabetes Care.¹

The association of impaired awareness of hypoglycemia with symptoms of anxiety and depression in 950 patients with type 1 diabetes was examined in this cross-sectional observational study carried out in the UK. Probable generalized anxiety disorder and major depressive disorder depression was found in nearly 10% participants each and 22.6% had impaired awareness of hypoglycemia.

After adjusting for sociodemographic and clinical variables, patients with symptoms of depression were at least 3-times more likely to be unaware of symptoms of hypoglycemia with odds ratio of 3.64, while patients with anxiety symptoms doubled their odds of having impaired awareness with OR of 2.46. The association between impaired awareness of hypoglycemia and anxiety and depression was stronger with increasing severity of symptoms. The prevalence of anxiety among the study subjects with impaired awareness of hypoglycemia was~15% vs 7.8% among those who did not have impaired awareness of hypoglycemia, while the prevalence of depression was 18.1% in those with impaired awareness of hypoglycemia vs 7.4% who were not unaware of imminent hypoglycemia. Eleven percent with impaired awareness of hypoglycemia had both anxiety and depression compared to ~5% without impaired awareness of hypoglycemia.

Although this study does not prove a cause-and-effect association between altered behavior or lack of motivation arising due to probable anxiety and depression and impaired awareness of hypoglycemia in patients with type 1 diabetes, it has demonstrated a significant association between the two. Hence, these patients should be routinely evaluated for anxiety and depression and managed appropriately for better quality of life and to prevent risk of severe hypoglycemic episodes.

Reference

1. Beatrice A Pieri, et al. Symptoms of anxiety and depression are independently associated with impaired awareness of hypoglycemia in type 1 diabetes. Diabetes Care. 2022 Oct 1;45(10):2456-2460. doi: 10.2337/dc21-2482.