Predictors of change in hypoglycemia unawareness among patients with type 1 diabetes

To analyse predictors of hypoglycemia unawareness (HU) and improvement in Clarke score in clinical practice.

We retrospectively identified patients with type 1 diabetes (T1D) at an academic T1D clinic who completed HU surveys 6-12 months apart. HU (Clarke score ≥4) and improvement in Clarke score (decrease by ≥1 point or more clinically relevant ≥2 point) were assessed in univariable relationships and using multivariable logistic regression.

Of the 300 participants, median diabetes duration was 19 years, 47 had HU at baseline, and 91 had an improvement by 1 point while 21 had an improvement by 2 points. Patients with baseline Clarke score ≥4 who had ≥1 or ≥2 point improvement had lower filtration rate (eGFR) than those who did not. After adjustment for other variables, gender (male OR 0.33, 95% CI 0.15, 0.74), log diabetes duration (OR 6.40, 95% CI 2.84, 14.5), and eGFR <60 ml/min/1.73 m² (5.56, 95% CI 1.98, 15.6) were independent predictors of baseline HU. Continuous glucose monitoring use (OR 2.04, 95% CI 1.20, 3.48) and log diabetes duration (OR 1.78, 95% CI 1.22, 2.60) were independent predictors of 1 point improvement and eGFR <60 ml/min/1.73 m² (OR 10.5, 95% CI 3.64, 30.0) and an education visit (OR 2.64, 95% CI 1.01, 6.89) were independent predictors of 2 point improvement in Clarke score.

Diabetes duration, gender, and eGFR were independent predictors of HU. Improvement in Clarke score is possible in patients with long-standing T1D, underscoring the need for additional study.