Protective and risk factors of impaired awareness of hypoglycemia in patients with type 1 diabetes: a cross-sectional analysis of baseline data from the PR-IAH study

Abstract

Background Hypoglycemia in type 1 diabetes (T1D) is associated with mortality and morbidity, especially when awareness of hypoglycemia is impaired. This study aimed to investigate the protective and risk factors for impaired awareness of hypoglycemia (IAH) in adults with T1D. Methods This cross-sectional study enrolled 288 adults with T1D (mean age, 50.4 ± 14.6 years; male, 36.5%; diabetes duration, 17.6 ± 11.2 years; mean HbA1c level, 7.7 ± 0.9%), who were divided into IAH and non-IAH (control) groups. A survey was conducted to assess hypoglycemia awareness using the Clarke questionnaire. Diabetes histories, complications, fear of hypoglycemia, diabetes distress, hypoglycemia problem-solving abilities, and treatment data were collected. Results The prevalence of IAH was 19.1%. Diabetic peripheral neuropathy was associated with an increased risk of IAH (odds ratio [OR] 2.63; 95% confidence interval [CI] 1.13–5.91; P = 0.014), while treatment with continuous subcutaneous insulin infusion and hypoglycemia problem-solving perception scores were associated with a decreased risk of IAH (OR, 0.48; 95% CI, 0.22–0.96; P = 0.030; and OR, 0.54; 95% CI, 0.37–0.78; P = 0.001, respectively). There was no difference in continuous glucose monitoring use between the groups. Conclusion We identified protective factors in addition to risk factors for IAH in adults with T1D. This information may help manage problematic hypoglycemia. Trial registration University hospital Medical Information Network (UMIN) Center: UMIN000039475). Approval date 13 February 2020.

Current and future therapies to treat impaired awareness of hypoglycemia

“…By temporarily suspending insulin delivery, SAP can avoid (or limit) the severity of hypoglycemia ( Steineck et al, 2017 ). SAPs have been shown to be useful in people with severe hypoglycemia ( Ly et al, 2013 ; Maahs et al, 2014 ; Bosi et al, 2019 ) and have improved hypoglycemia awareness ( Quirós et al, 2016 ; Sakane et al, 2023 ). One such study investigating T1D subjects with IAH (based on the Clarke questionnaire) were assessed at baseline and 3 and 6-month follow-ups after SAP + CGM implementation.…”