Efficacy of selected scales in the assessment of impaired awareness of hypoglycemia in adults with type 1 diabetes.

Introduction: Impaired awareness of hypoglycemia (IAH) increases the risk of severe hypoglycemia. Questionnaires may allow for easy identification of patients with IAH and facilitate appropriate interventions.

Objectives: This study aims to assess the clinical utility of the questionnaires commonly used for diagnosing IAH, providing practical insight for medical professionals. Additionally, we sought to identify clinical factors associated with IAH in adults with type 1 diabetes (T1D), enhancing the understanding of this condition in a real‑world context.

Patients and methods: The study included 252 adults with T1D (135 men), at a median (interquartile range) age of 41 (30-52) years. We evaluated their awareness of hypoglycemia using the validated questionnaires (Clarke scale, Gold scale, and Hypoglycemia Awareness Questionnaire [HypoA‑Q]), anthropometric data, and metabolic control data. To estimate the optimal cutoff point for the diagnosis of IAH using HypoA‑Q, we used the receiver operating characteristic (ROC) curve analysis. IAH was diagnosed based on at least 1 abnormal questionnaire score.

Results: We found a cutoff of 9 points for diagnosing IAH with HypoA‑Q (sensitivity, 79%; specificity, 82%; area under the ROC curve, 0.898). IAH in any test was found in 98 patients (39%). In the univariable logistic regression models, the diagnosis of IAH was associated with lifetime episodes of severe hypoglycemia, hypertension, glycated hemoglobin level, mean glycemia, standard deviation, total cholesterol, low‑density lipoprotein cholesterol, non-high‑density lipoprotein cholesterol, and daily dose of insulin.

Conclusions: HypoA‑Q, with a 9‑point cutoff, demonstrated the highest sensitivity in diagnosing IAH, and may be considered the most valuable screening tool for IAH detection.