Impaired Awareness of Hypoglycemia Poses T1D Threat

The study covered in this summary was published on Research Square as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Hypoglycemia problem-solving perception and use of real-time continuous glucose monitoring (rtCGM) appeared to protect against recurrent severe hypoglycemia (RSH) for Japanese adults with type 1 diabetes.

  • In clinical practice, physicians should be proactive in asking people with type 1 diabetes whether, and at which glucose level, they feel hypoglycemic in order to assess for impaired awareness of hypoglycemia (IAH) and to adjust the individual’s glucose targets to prevent severe hypoglycemia (SH).

Why This Matters

Study Design

  • The cross-sectional study involved 287 adults who were at least 20 years old and who had type 1 diabetes and confirmed IAH; 17 patients had a solitary SH episode, eight had recurrent episodes, and 262 had no SH, defined as an event that required assistance from another individual to administer carbohydrates or glucagon or to take another corrective action.

  • The researchers considered SH recurrent if a person had had more than one episode within a year.

  • The researchers assessed IAH using Gold’s questionnaire, which asks the question: Do you know when your hypoglycemia is commencing?”

  • They assessed hypoglycemia problem-solving abilities with the 24-item Hypoglycemia Problem-Solving Scale.

Key Results

  • The average age of the patients was 50 years, the average diabetes duration was 18 years, and the average A1c level was 7.7%.

  • The overall SH rate was 16.7/100 person-years.

  • Both diabetic peripheral neuropathy (DPN) and IAH were associated with a significantly increase in the rate of RSH; odds ratios in comparison with people without these features were 5.53 and 4.82, respectively.

  • Having a higher hypoglycemia problem-solving scale perception score was significantly linked with a decrease in the rate of both solitary SH and RSH; odds ratios were 0.52 and 0.35, respectively. Scores for other hypoglycemia problem-solving scale categories did not have significant associations.

  • Use of rtCGM was significantly associated with reduced rates of SH and RSH, but no differences were linked with the use of intermittently scanned CGM.

  • The prevalence of IAH significantly increased as the incidence of SH events increased.


  • The study included few people with RSH.

  • The researchers did not assess for diabetic cardiac autonomic neuropathy.

  • The researchers did not evaluate the severity of DPN.


  • The study received no commercial funding.

  • The authors have disclosed no relevant financial relationships.

This is a summary of a preprint research study, “Protective and Risk Factors of Recurrent Severe Hypoglycemia in Adults With Type 1 Diabetes: A Cross-Sectional Analysis of Baseline Data From the PR-IAH Study,” written predominantly by a team of researchers from various center in Japan and published on Research Square. The summary was provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on

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