Predictors of impaired awareness of hypoglycaemia and severe hypoglycaemia in adults with type 1 diabetes

Abstract

Aims: This study aimed to assess the prevalence of impaired awareness of hypoglycaemia (IAH) and severe hypoglycaemia (SH) in adults with type 1 diabetes and identify risk factors for both conditions in a contemporary cohort. Methods: A cross-sectional survey was conducted on 782 adults with type 1 diabetes. Participants completed a questionnaire including validated hypoglycaemia awareness and mental health tools. Continuous glucose monitoring (CGM) data were collected in 402 participants. SH was identified based on self-reported episodes. Results: 89% were CGM users and 27% were using continuous subcutaneous insulin infusion (CSII). 5.3% of participants reported a recent episode of SH and 21% had IAH based on the Gold score. Elevated Gold Score was independently associated with socioeconomic deprivation (OR 1.9, p = 0.002), female sex (OR 1.8, p = 0.002) and positive depression screen (OR 2.1, p = 0.007). Hypoglycaemia detection threshold <3.0 mM was independently associated with older age (OR 1.03 per year, p < 0.001) and positive depression screen (OR 2.7, p < 0.001). Greater glucose variability (OR 1.14 per % CV glucose, p < 0.001), positive anxiety screen (OR 3.0, p = 0.031) and detection threshold <3.0 mM (OR 6.7, p < 0.001) were all independently associated with SH risk. Conclusions: The prevalence of SH is lower in the modern era of type 1 diabetes management and may reflect greater use of CGM and CSII. Mental health symptoms and socioeconomic deprivation are key associations with IAH and SH. Risk models incorporating clinical, psychological and CGM data may more effectively predict SH.