The Impact Of Anxiety And Depression In Type 1 Diabetes Mellitus (T1dm) Patients Who Experience Severe Hypoglycemic Episodes (Hypos)

Severe hypos can be debilitating for patients and can be associated with anxiety and/or depression [A+/-D]. The objective of this analysis is to consider the incremental impact of A+/-D in patients who experience severe hypos. Data were drawn from 2016 Adelphi Disease Specific Programme, a real-world, cross-sectional study in 5EU/USA. Physicians completed forms for the next 2 T1DM patients capturing comorbidities (including anxiety, depression), demographics, disease duration, hypo severity [mild: self-managed, severe: requiring non-medical or medical help], resource utilization. Patients self-reported work, activity impairment, lifestyle impact. To assess differences OLS regressions were conducted for continuous outcomes and logit models for binary outcomes. Regressions accounted for confounding variables: gender, disease duration, BMI. The independent variable was no physician-reported A+/-D vs. A+/-D. Of 1662 patients, 861 (51.8%) never experienced hypos, 637 (38.3%) mild and 164 (9.9%) severe. Of those patients with severe hypos, 27 (16.5%) had A+/-D. Diagnosis of A+/-D was associated with increased time missed from work, (+30.21%, n=37, p<0.001), no difference was observed in productivity while at work. These patients had 2.29 more physician consultations than those without A+/-D (n=131, p=0.031). They also had a greater need for caregiver involvement, although not statistically significant (n=130, p=0.051). Regarding lifestyle, these patients were more likely to be in the sometimes/greatly affected category for appearance/self-confidence issues (OR coefficient:13.54, base=1, n=80, p=0.002), although factors such as freedom to eat/drink, take long journeys, feelings about the future, impact on leisure activities were similar. This study demonstrated there is significant incremental burden of anxiety and depression in T1DM patients who experience severe hypos. Physicians should take steps to recognize and manage these conditions.