Prevalence of impaired awareness of hypoglycaemia in people with diabetes mellitus: A systematic review and meta‐analysis from 21 countries and regions

Abstract

AimsImpaired awareness of hypoglycaemia (IAH) is a complication of glucose‐lowering therapies for diabetes. The purpose of this review was to estimate the pooled prevalence of IAH and unawareness of hypoglycaemia (UAH).MethodsWe searched the major databases from inception to 8 August 2022 and included all cross‐sectional and cohort studies reporting IAH prevalence in people with diabetes. A random‐effects model was used to pool effect values. Subgroup analysis and meta‐regression were used to identify study‐level characteristics affecting prevalence.ResultsSixty‐two studies from 21 countries published between 2000 and 2022 were included, with 39,180 participants (type 1 diabetes: 19,304 vs. Type 2 diabetes: 14,650). The pooled prevalence was 23.2% (95% CI: 18.4%–29.3%) via the Clarke questionnaire, 26.2% (95% CI: 22.9%–29.9%) via the Gold score, and 58.5% (95% CI: 53.0%–64.6%) via the Pedersen‐Bjergaard method, all from studies classified as presenting a moderate and low risk of bias. The prevalence of IAH was generally higher in people with type 1 diabetes than in those with type 2 diabetes and lowest in Europe. Meta‐regression results show that the duration of diabetes was a factor influencing the prevalence of IAH. The prevalence of UAH by the Pedersen‐Bjergaard method was 17.6 (95% CI: 14.9%–20.3%).ConclusionsIAH is a prevalent risk event among people with type 1 and type 2 diabetes, showing clinical heterogeneity and regional variability. UAH, an adverse progression of IAH, is also a serious burden. More primary research on the prevalence of IAH is needed in areas with a high diabetes burden.

Person‐reported outcomes in diabetes care: What are they and why are they so important?

“…38 Another consideration is the specificity of the selected PROMs or PREMs to the effect of an evalu- T A B L E 1 Core person-reported outcomes and person-reported experiences. 94 • Risk factor for future severe hypoglycaemia 95 • Sensitivity to change can be questioned 95…”

Household food insecurity is associated with greater autonomic dysfunction testing score in Latinos with type 2 diabetes

“…People with hypoglycemia unawareness are also less likely to be awakened from sleep when hypoglycemia occurs at night. Impaired awareness of hypoglycemia is a common problem [42]. Hypoglycemia unawareness may be one reason, in addition to lack of food, for the elevated rates of severe hypoglycemia and emergency department visits observed in food insecure individuals [4].…”

Maintaining awareness

“…In this issue, the prevalence of impaired awareness of hypoglycaemia is described from a systematic review and meta-analysis of data from 21 countries across the world. 1 Impaired awareness remains prevalent, affecting around one in four people with diabetes, depending on the tool used to assess it, and affects people with type 1 diabetes more than type 2 diabetes. The principle factor associated with impaired awareness is diabetes duration, suggesting that impaired awareness is likely to be more prevalent in older people living with type 1 diabetes.…”

“…And yet, despite this extraordinary advance, diabetes remains challenging to live with and still has significant consequences for people with diabetes. In this issue, the prevalence of impaired awareness of hypoglycaemia is described from a systematic review and meta‐analysis of data from 21 countries across the world 1 . Impaired awareness remains prevalent, affecting around one in four people with diabetes, depending on the tool used to assess it, and affects people with type 1 diabetes more than type 2 diabetes.…”