Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 14;19(6):e0297601.
doi: 10.1371/journal.pone.0297601. eCollection 2024.

A cross-sectional questionnaire study: Impaired awareness of hypoglycaemia remains prevalent in adults with type 1 diabetes and is associated with the risk of severe hypoglycaemia

Faye Baxter  1 , Nicola Baillie  1 , Anna Dover  2 , Roland H Stimson  1   2 , Fraser Gibb  2 , Shareen Forbes  1   2
Affiliations

A cross-sectional questionnaire study: Impaired awareness of hypoglycaemia remains prevalent in adults with type 1 diabetes and is associated with the risk of severe hypoglycaemia

Faye Baxter et al. PLoS One. .

Abstract

Objective: Impaired awareness of hypoglycaemia (IAH) is a risk factor for severe hypoglycaemia (SH) in type 1 diabetes (T1D). Much of the IAH prevalence data comes from older studies where participants did not have the benefit of the latest insulins and technologies. This study surveyed the prevalence of IAH and SH in a tertiary adult clinic population and investigated the associated factors.

Methods: Adults (≥18 years) attending a tertiary T1D clinic completed a questionnaire, including a Gold and Clarke score. Background information was collected from health records.

Results: 189 people (56.1% female) with T1D (median [IQR] disease duration 19.3 [11.5, 29.1] years and age of 41.0 [29.0, 52.0] years) participated. 17.5% had IAH and 16.0% reported ≥1 episode of SH in the previous 12 months. Those with IAH were more likely to report SH (37.5% versus 11.7%, p = 0.001) a greater number of SH episodes per person (median [IQR] 0 [0,2] versus 0 [0,0] P<0.001) and be female (72.7% versus 52.6%, p = 0.036). Socio-economic deprivation was associated with IAH (p = 0.032) and SH (p = 0.005). Use of technology was the same between IAH vs aware groups, however, participants reporting SH were more likely to use multiple daily injections (p = 0.026). Higher detectable C-peptide concentrations were associated with a reduced risk of SH (p = 0.04).

Conclusion: Insulin pump and continuous glucose monitor use was comparable in IAH versus aware groups. Despite this, IAH remains a risk factor for SH and is prevalent in females and in older people. Socioeconomic deprivation was associated with IAH and SH, making this an important population to target for interventions.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
A. Respondents reporting severe hypoglycaemia in the previous 12 months.Percentage of participants reporting at least one episode of SH in the preceding 12 months categorised by normal vs impaired awareness of hypoglycaemia. B. Number of severe hypoglycaemia events per patient in the previous 12 months.Number of episodes of SH per participant in the preceding 12 months, categorised by normal vs impaired awareness of hypoglycaemia. (Interquartile and absolute ranges shown by violin plot).
Fig 2
Fig 2. Impaired awareness of hypoglycaemia by SIMD quintile.
Impaired awareness by SIMD quintile. Quintile 1 is the most deprived. Chi-squared analysis showed a statistically significant difference between the proportions with IAH between quintiles, p = 0.01.
Fig 3
Fig 3. History of severe hypoglycaemia in the past 12 months and random C-peptide level.
Random C-peptide levels in participants with ≥1SH vs. none in the preceding 12 months. C peptide levels between the groups was statistically significant.
See this image and copyright information in PMC

References

    1. Scottish Diabetes Survey 2020: Scottish Diabetes Data Group; [Available from: https://www.diabetesinscotland.org.uk/wp-content/uploads/2022/01/Diabete....
    1. Rickels MR. Hypoglycemia-associated autonomic failure, counterregulatory responses, and therapeutic options in type 1 diabetes. Ann N Y Acad Sci. 2019;1454(1):68–79. doi: 10.1111/nyas.14214 - DOI - PMC - PubMed
    1. Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al.. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86. doi: 10.1056/NEJM199309303291401 - DOI - PubMed
    1. Khunti K, Alsifri S, Aronson R, Cigrovski Berković M, Enters-Weijnen C, Forsén T, et al.. Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes Obes Metab. 2016;18(9):907–15. doi: 10.1111/dom.12689 - DOI - PMC - PubMed
    1. Verhulst CEM, Fabricius TW, Teerenstra S, Kristensen PL, Tack CJ, McCrimmon RJ, et al.. Glycaemic thresholds for counterregulatory hormone and symptom responses to hypoglycaemia in people with and without type 1 diabetes: a systematic review. Diabetologia. 2022;65(10):1601–12. doi: 10.1007/s00125-022-05749-8 - DOI - PMC - PubMed