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 Oct 1;47(10):1769-1777.
doi: 10.2337/dc23-2332.

Relationship Between Sensor-Detected Hypoglycemia and Patient-Reported Hypoglycemia in People With Type 1 and Insulin-Treated Type 2 Diabetes: The Hypo-METRICS Study

Patrick Divilly  1   2 , Gilberte Martine-Edith  1 , Natalie Zaremba  1 , Uffe Søholm  3   4 , Zeinab Mahmoudi  5 , Monika Cigler  6 , Namam Ali  7 , Evertine J Abbink  7 , Julie Brøsen  8 , Bastiaan de Galan  7   9 , Ulrik Pedersen-Bjergaard  8   10 , Allan A Vaag  11 , Rory J McCrimmon  12 , Eric Renard  13   14 , Simon Heller  15 , Mark Evans  16 , Julia K Mader  6 , Stephanie A Amiel  1 , Frans Pouwer  4   17 , Pratik Choudhary  1   18 ; Hypo-RESOLVE Consortium
Affiliations

Relationship Between Sensor-Detected Hypoglycemia and Patient-Reported Hypoglycemia in People With Type 1 and Insulin-Treated Type 2 Diabetes: The Hypo-METRICS Study

Patrick Divilly et al. Diabetes Care. .

Abstract

Objective: Use of continuous glucose monitoring (CGM) has led to greater detection of hypoglycemia; the clinical significance of this is not fully understood. The Hypoglycaemia-Measurement, Thresholds and Impacts (Hypo-METRICS) study was designed to investigate the rates and duration of sensor-detected hypoglycemia (SDH) and their relationship with person-reported hypoglycemia (PRH) in people living with type 1 diabetes (T1D) and insulin-treated type 2 diabetes (T2D) with prior experience of hypoglycemia.

Research design and methods: We recruited 276 participants with T1D and 321 with T2D who wore a blinded CGM and recorded PRH in the Hypo-METRICS app over 10 weeks. Rates of SDH <70 mg/dL, SDH <54 mg/dL, and PRH were expressed as median episodes per week. Episodes of SDH were matched to episodes of PRH that occurred within 1 h.

Results: Median [interquartile range] rates of hypoglycemia were significantly higher in T1D versus T2D; for SDH <70 mg/dL (6.5 [3.8-10.4] vs. 2.1 [0.8-4.0]), SDH <54 mg/dL (1.2 [0.4-2.5] vs. 0.2 [0.0-0.5]), and PRH (3.9 [2.4-5.9] vs. 1.1 [0.5-2.0]). Overall, 65% of SDH <70 mg/dL was not associated with PRH, and 43% of PRH had no associated SDH. The median proportion of SDH associated with PRH in T1D was higher for SDH <70 mg/dL (40% vs. 22%) and SDH <54 mg/dL (47% vs. 25%) than in T2D.

Conclusions: The novel findings are that at least half of CGM hypoglycemia is asymptomatic, even below 54 mg/dL, and many reported symptomatic hypoglycemia episodes happen above 70 mg/dL. In the clinical and research setting, these episodes cannot be used interchangeably, and both need to be recorded and addressed.

PubMed Disclaimer

Conflict of interest statement

Duality of Interest. P.D. has spoken at an educational symposium sponsored by Novo Nordisk. S.A.A. has served on advisory boards for Novo Nordisk and Medtronic and has spoken at an educational symposium sponsored by Sanofi. M.E. has served on advisory boards and/or received lecture fees and/or research support from Novo Nordisk, Eli Lilly, AstraZeneca, Medtronic, Dexcom, Ypsomed, Abbott Diabetes Care, Roche, NGM Pharma, Zucara, Pila Pharma, and Sanofi. U.P.-B. has served on advisory boards for Novo Nordisk, Sanofi, and Vertex and has received lecture fees from Novo Nordisk and Sanofi. J.K.M. is a member of the advisory boards of Boehringer Ingelheim, Eli Lilly, Medtronic, Novo Nordisk AS, Prediktor A/S, Roche Diabetes Care, and Sanofi-Aventis Deutschland GmbH and received speaker honoraria from Abbott Diabetes Care, Astra Zeneca, Dexcom, Eli Lilly, Medtronic, MSD, Novo Nordisk AS, Roche Diabetes Care, Sanofi, Servier, and Takeda. She is shareholder of decide Clinical Software GmbH and elyte diagnostics. E.R. has served as consultant/advisor for Abbott, Air Liquide SI, AstraZeneca, Boehringer-Ingelheim, Dexcom, Eli Lilly, Hillo, Insulet, Medirio, Novo Nordisk, Roche, Sanofi-Aventis Deutschland GmbH, and Tandem and received research support from Dexcom, Insulet, and Tandem. P.C. has received personal fees Abbott Diabetes Care, Insulet, Dexcom, Novo Nordisk, AstraZeneca, Medtronic, Roche Diabetes Care, and Sanofi Diabetes and research funding support from Abbott Diabetes Care, Medtronic, and Novo Nordisk. R.J.M. has served on advisory boards and/or received lecture fees and/or research support from Sanofi and Novo Nordisk. F.P. has received funding for research from Novo Nordisk, Eli Lilly, and Sanofi-Aventis Deutschland GmbH. S.H. has served on advisory boards for Zealand Pharma and Zucara Pharma, and received research support from Dexcom and lecture fees from Novo Nordisk and Medtronic. No other potential conflicts of interest relevant to this article were reported.

Figures

None
Graphical abstract
Figure 1
Figure 1
A: Median rates of SDH in T1D and T2D. B: Median rates of PRH in T1D and T2D. C: Median duration (P value <0.001) of SDH in T1D and T2D.
Figure 2
Figure 2
A: The proportion of matched and unmatched SDH <70 mg/dL and PRH in all participants. B: The proportion of matched and unmatched SDH <70 mg/dL and PRH in T1D. C: The proportion of matched and unmatched SDH <70 mg/dL and PRH in T2D.
Figure 3
Figure 3
Median percentage of SDH detected by individuals with T1D and T2D (A) at SDH <70 mg/dL and (B) at SDH <54 mg/dL.
See this image and copyright information in PMC

References

    1. Heinemann L, Freckmann G, Ehrmann D, et al. . Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet 2018;391:1367–1377 - PubMed
    1. Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline J-P, Rayman G. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther 2017;8:55–73 - PMC - PubMed
    1. Amiel SA, Aschner P, Childs RNB, et al. . Glucose concentrations of less than 3.0 mmol/l (54 mg/dl) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2017;60:3–6 - PMC - PubMed
    1. Battelino T, Alexander CM, Amiel SA, et al. . Continuous glucose monitoring and metrics for clinical trials: an international consensus statement. Lancet Diabetes Endocrinol 2023;11:42–57 - PubMed
    1. Henriksen MM, Andersen HU, Thorsteinsson B, Pedersen-Bjergaard U. Hypoglycemic exposure and risk of asymptomatic hypoglycemia in type 1 diabetes assessed by continuous glucose monitoring. J Clin Endocrinol Metab 2018;103:2329–2335 - PubMed

MeSH terms