# A Mixed Methods Investigation of Attitudes and Self-Care in Individuals with Type-1 Diabetes Mellitus with Intact and Impaired Awareness of Hypoglycemia

> **NIH NIH F31** · UNIVERSITY OF PENNSYLVANIA · 2022 · $46,752

## Abstract

Project Summary
Hypoglycemia is an inevitable consequence of insulin therapy. Individuals with type-1 diabetes mellitus (T1DM)
rely on symptom perception as the primary physiologic defense against developing severe hypoglycemia. Up to
60% of individuals with T1DM experience blunting of the sympathoadrenal response to hypoglycemia that results
in impaired awareness of hypoglycemia (IAH). Those with IAH have a significantly higher likelihood of
experiencing severe, life-threatening hypoglycemia. Racial disparities exist between Black and White individuals
regarding incidence of severe hypoglycemia and prevalence of IAH. Further, current approaches to remedying
IAH rely on advanced technologies, a form of intervention that Black individuals are significantly less likely to
adopt. To reduce risk for severe hypoglycemic events and disparities, novel approaches to understanding IAH
are warranted. Hypoglycemia awareness may be restored with significant hypoglycemia avoidance, yet we
believe that many individuals are unable to achieve sufficient avoidance to restore awareness due to self-care
behaviors that cause frequent iatrogenic hyperinsulinemia, and resultant hypoglycemia. Individuals with IAH
have been shown to hold unique attitudes and beliefs that may encourage these behaviors. This fellowship
application will determine differentiating attitudes and self-care of individuals with IAH, describe the common
attitude and self-care profiles of individuals with IAH, and more deeply explain findings qualitatively to launch a
line of inquiry for a career investigating these relationships. The specific aims of the study are to (1) compare the
attitudes and self-care behaviors in adults with T1DM with and without IAH, (2) identify clusters of attitudes and
self-care behavior patterns that correspond best with IAH classification, and (3) explore the relationship between
attitudes and self-care in a racially diverse group of adults with T1DM complicated and uncomplicated by IAH to
better explain patterns observed in cluster analysis. Data will be collected from a sample of patients at the Penn
Rodebaugh Diabetes Center, the largest diabetes center in the University of Pennsylvania Health System. Data
will first be analyzed with ANCOVA to compare attitudes and self-care behaviors of those with and without IAH
while holding recognized covariates constant. Then, we will perform a cluster analysis using Ward’s minimum
variance method to determine what attitude and self-care patterns correspond most with IAH classification in
adults with T1DM. Finally, we will perform qualitative directed content analysis of interviews of individuals with
IAH who were clustered into the group determined to correspond best with IAH to explain results. This fellowship
application will provide the applicant training and research experiences necessary to become an independent
nurse researcher with developing expertise in self-care, attitudes, and IAH in individuals with T1DM. This
pro...

## Key facts

- **NIH application ID:** 10462958
- **Project number:** 1F31NR020137-01A1
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Austin M Matus
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $46,752
- **Award type:** 1
- **Project period:** 2022-05-01 → 2023-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10462958

## Citation

> US National Institutes of Health, RePORTER application 10462958, A Mixed Methods Investigation of Attitudes and Self-Care in Individuals with Type-1 Diabetes Mellitus with Intact and Impaired Awareness of Hypoglycemia (1F31NR020137-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10462958. Licensed CC0.

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