Background: Hyper-/hypoglycemia unawareness harvours one of the major issues to hamper good clinical practice in people with type 2 diabetes (T2DM). To unveil risk factors of hyper-/hypoglycemia unawareness, we investigated its relationship with actual glucose variability in people with T2DM using continuous glucose monitoring (CGM).

Methods: Data were obtained from our prospective observational study comprising Japanese people with T2DM who underwent blinded professional CGM and the Diabetes Treatment Satisfaction Questionnaire (DTSQ). People with a time above range (TAR; >180 mg/dL) ≥25% and those who answered 0 (“never”) or +1 (“almost never”) for the frequency of hyperglycemia in the DTSQ were defined as having hyperglycemia unawareness. People with a time below range (TBR; <70 mg/dL) ≥4% with an answer of 0 or +1 for the frequency of hypoglycemia were labelled as having hypoglycemia unawareness. We extracted various clinical characteristics associated with the discrepancies between hyper-/hypoglycemia unawareness and TAR ≥25% / TBR ≥4% on a multivariate logistic regression analysis.

Results: This analysis included 284 subjects. In subjects with a TAR ≥25% (n=115), 27 had hyperglycemia unawareness. The analysis showed that each of no insulin use, older age, and a history of stroke was correlated with hyperglycemia unawareness. Among subjects with a TBR ≥4% (n=45), 28 were unaware of their hypoglycemia. A low eGFR was an independent risk of hypoglycemia unawareness.

Conclusions: We newly identified some clinical characteristics that were significantly associated with hyper-/hypoglycemia unawareness. In people with those characteristics, careful and intensive information sharing regarding asymptomatic hyper-/hypoglycemia using CGM may lead to better glucose management.


Y.Suzuki: None.

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