Protective and risk factors of recurrent severe hypoglycemia in adults with type 1 diabetes: A cross-sectional analysis of baseline data from the PR-IAH study

Background Severe hypoglycemia (SH) remains a central problem in the management of type 1 diabetes (T1D); however, little is known about the protective and risk factors associated with recurrent SH (RSH). This study aimed to identify the protective and risk factors for RSH in adults with T1D. Methods This cross-sectional study enrolled 287 adults with T1D (mean age: 50.3 ± 14.5 years, male: 36.2%, diabetes duration: 17.6 ± 11.2 years, mean HbA1c: 7.7 ± 0.9%) and divided them into non-SH (n = 262), solitary SH (n = 17), and RSH (n = 8) groups. Impaired awareness of hypoglycemia (IAH) assessed using the Gold’s method, diabetic complications, fear of hypoglycemia, diabetes distress, hypoglycemia problem solving abilities, and treatment data were collected. Results The overall SH rate was 16.7/100 person-years. The odds ratios of diabetic peripheral neuropathy and IAH were associated with an increased risk of RSH (odds ratio [OR]: 5.53 ,95% confidence interval [CI]: 1.18–25.98 and OR: 4.82 [95% CI:1.09–21.23], respectively); hypoglycemia problem-solving perception score was associated with a decreased risk of RSH (OR: 0.35 [95% CI: 0.18–0.69]). The rate of rtCGM use decreased as the SH category increased, but no difference was found in the rate of isCGM use. Conclusion We identified the protective factors, such as hypoglycemia problem-solving perception, in addition to the risk factors for RSH in adults with T1D. Trial registration: University hospital Medical Information Network (UMIN) Center: UMIN000039475)、Approval date 13 February 2020