Hypoglycemia unawareness in type 1 diabetes patients using intermittent continuous glucose monitoring: Identification of risk factors and glycemic patterns

Background: Hypoglycemia unawareness designates failure to detect eminent hypoglycemia. Clarke's questionnaire is one of the most used systems to evaluate this problem. Aims: To relate Clarke's questionnaire (QQ) results with continuous glucose monitoring data. Methods: Application of the questionnaire in a sample of type 1 diabetes mellitus (T1DM) patients using intermittent continuous glucose monitoring (iCGM). Results: 111 T1DM patients were evaluated, 56.8% female, mean age 35.0 +/- 12.4 years and mean disease duration 18.8 +/- 10.5 years. According to CQ, 13.5% had unawareness, 76.6% awareness and 9.9% indeterminate awareness to hypo-glycemia. Those with unawareness had longer disease duration (25.1 +/- 10.4 vs 18.2 +/- 10.3 for awareness and 14.9 +/- 9.9 for indeterminate awareness, p = 0.047), more time below range (10.3 +/- 4.9% vs 6.3 +/- 5.1 and 6.3 +/- 4.8; p = 0.009) and higher mean duration of hypoglycemia (131.7 +/- 38.6 vs 116.6 +/- 49.6 and 131.7 +/- 38.6; p = 0.008). In multivariate analysis, mean duration of hypoglycemia was an independent predictor of CQ results. In a receiver operating curve (AUC 0.746; p = 0.004) a mean duration of hypo-glycemia >106.5 min showed 84.6% sensitivity/64.4% specificity for unawareness. Conclusions: Our sample had a significative prevalence of hypoglycemia unawareness which increased with longer diabetes duration. iCGM data can be indicative of this problem, with a mean hypoglycemia duration >106.5 min being suggestive, albeit unspecific. (c) 2022 Diabetes India. Published by Elsevier Ltd. All rights reserved.