Impact of severe hypoglycaemia on psychological outcomes in adults with Type 2 diabetes: a systematic review

Aim
Hypoglycaemia affects many people with Type 2 diabetes using insulin and other glucose‐lowering therapies. This systematic review examined the impact of severe hypoglycaemia (episodes requiring external assistance) on psychological outcomes (e.g. emotional well‐being, health status and quality of life) in adults with Type 2 diabetes.

Methods
MEDLINE Complete, PsycINFO and CINAHL databases were searched for peer‐reviewed empirical studies, published in English, reporting the occurrence and severity of hypoglycaemia and its relationship with patient‐reported outcomes (PROs) in adults with Type 2 diabetes. Data were extracted from published reports and analysed.

Results
Of 3756 potentially relevant abstracts, 29 studies met the inclusion criteria. Most reported cross‐sectional data and sample sizes varied widely (N = 71 to 17 563). Although definitions of mild and severe hypoglycaemia were largely consistent between studies, additional non‐standard categorizations (e.g. moderate, very severe) were apparent and recall periods varied. Overall, severe hypoglycaemia was associated with increased fear of hypoglycaemia and decreased emotional well‐being, health status and diabetes‐specific quality of life. Effect sizes show that the association with fear of hypoglycaemia was stronger than with general health status.

Conclusions
Notwithstanding the limitations of the empirical studies, these findings indicate that severe hypoglycaemia in adults with Type 2 diabetes (insulin‐ and non‐insulin‐treated) is associated with impaired psychological outcomes. Healthcare professionals should address the psychological impact of severe hypoglycaemia during clinical consultations, to support individuals to minimize exposure to, and the psychological consequences of, severe hypoglycaemia.