Further investigation into the real-world etiology of impaired awareness of hypoglycemia (IAH) in T2DM is needed. The present study aims to address this research gap by providing pragmatic, population-based insight into IAH and its risk indicators.

A validated questionnaire (InHypo-DMPQ) was administered online to a nationally representative panel comprising Canadians (≥18 years) with T2DM taking insulin and/or secretagogues. Data were collected on respondents’ socio-demographic/clinical traits, self-reported hypoglycemia, and severity of IAH (no, moderate, and severe). Multivariable partial proportional odds (PPO) regression was used to identify the relevant risk indicators of moderate and severe IAH. Covariates were selected in consultation with the literature and clinical experts.

A complete case analysis of 432 respondents (mean age: 53.0 (SD: 14.7) years; male: 56%) was undertaken. Of these individuals, 28% were classified with severe IAH, 66% with moderate IAH, and 6% with no IAH. Age, diabetes duration, A1C, total annual history of hypoglycemia (any type), therapeutic regimen, comorbidity status, gender, income, education, and drug coverage status were assessed for their influence on IAH severity. Based on the multivariable PPO model, a 5-year increase in diabetes duration decreased the adjusted odds of moderate or severe IAH, relative to no IAH, by 24% (95% CI: 12-35%, p<0.001). Moreover, the adjusted odds of severe IAH classification, versus no or moderate IAH, increased by a factor of 1.09 (95% CI: 1.02-1.15, p=0.008) for every 15 hypoglycemic events reported (in the past year).

These results will help inform the improved management of IAH in real-world clinical settings. To reduce the risk of severe IAH in T2DM, clinical interventions should prioritize the reduction of hypoglycemic events. In particular, supporting patients with more recent T2DM diagnoses toward accurately recognizing their hypoglycemia symptoms may forestall the onset of IAH and related sequelae.


A. Ratzki-Leewing: None. S.B. Harris: Advisory Panel; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly/Boehringer Ingelheim, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Consultant; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly/Boehringer Ingelheim, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Abbott, AstraZeneca, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Other Relationship; Self; Canadian Diabetes Association, Canadian Institutes of Health Research, The Lawson Foundation. N.H. Au: None. S. Webster-Bogaert: None. J.B. Brown: None. S.M. Reichert: Advisory Panel; Self; Abbott, AstraZeneca, Novo Nordisk Inc., Sanofi, Servier. Research Support; Self; Canadian Institutes of Health Research. Speaker's Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi. B.L. Ryan: None.


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