Reduced Prevalence of Impaired Awareness of Hypoglycemia Over Two Decades in Population-Based Samples of Youth With Type 1 Diabetes.

Abstract

To investigate the change in prevalence of impaired awareness of hypoglycemia (IAH) and severe hypoglycemia (SH) across three cohorts (2002, 2015, and 2024) in youth with type 1 diabetes. Youth (12-18 years old) completed a Modified Clarke questionnaire to assess IAH. Prevalence of IAH and recent SH was compared across cohorts. Continuous glucose monitoring (CGM)-derived metrics were compared between those with and without IAH in 2024. IAH prevalence was 15.9% compared with 33.1% in 2002 (P < 0.001) and 21.4% in 2015 (P = 0.051). The 2024 SH rate was 0.92 per 100 patient-years, 3.5-fold lower (95% CI 1.2, 12.5) than in 2015 and 30-fold lower (12.7, 98.9) than in 2002 despite HbA1c reduction across cohorts (P < 0.001). Hypoglycemia exposure did not differ between IAH and non-IAH when analyzing CGM metrics (P > 0.05). IAH and SH have declined substantially over two decades, reflecting improved diabetes care. However, ongoing IAH signifies the need for routine screening.