Relationship Between Sensor-Detected Hypoglycemia and Patient-Reported Hypoglycemia in People With Type 1 and Insulin-Treated Type 2 Diabetes: The Hypo-METRICS Study

Hypo-RESOLVE Consortium; Patrick Divilly; Gilberte Martine-Edith; Natalie Zaremba; Uffe Søholm; Zeinab Mahmoudi; Monika Cigler; Namam Ali; Evertine J. Abbink; Julie Brøsen; Bastiaan de Galan; Ulrik Pedersen-Bjergaard; Allan A. Vaag; Rory J. McCrimmon; Eric Renard; Simon Heller; Mark Evans; Julia K. Mader; Stephanie A. Amiel; Frans Pouwer; Pratik Choudhary

doi:10.2337/dc23-2332

Relationship Between Sensor-Detected Hypoglycemia and Patient-Reported Hypoglycemia in People With Type 1 and Insulin-Treated Type 2 Diabetes: The Hypo-METRICS Study

Hypo-RESOLVE Consortium
, Patrick Divilly (Lead / Corresponding author)
, Gilberte Martine-Edith
, Natalie Zaremba
, Uffe Søholm
, Zeinab Mahmoudi
, Monika Cigler
, Namam Ali
, Evertine J. Abbink
, Julie Brøsen
, Bastiaan de Galan
, Ulrik Pedersen-Bjergaard
, Allan A. Vaag
, Rory J. McCrimmon
, Eric Renard
, Simon Heller
, Mark Evans
, Julia K. Mader
, Stephanie A. Amiel
, Frans Pouwer

Pratik Choudhary

Research output: Contribution to journal › Article › peer-review

32 Citations (Scopus)

111 Downloads (Pure)

Abstract

OBJECTIVE

Use of continuous glucose monitoring (CGM) has led to greater detection of hypoglycemia; the clinical significance of this is not fully understood. The Hypoglycaemia-Measurement, Thresholds and Impacts (Hypo-METRICS) study was designed to investigate the rates and duration of sensor-detected hypoglycemia (SDH) and their relationship with person-reported hypoglycemia (PRH) in people living with type 1 diabetes (T1D) and insulin-treated type 2 diabetes (T2D) with prior experience of hypoglycemia.

RESEARCH DESIGN AND METHODS

We recruited 276 participants with T1D and 321 with T2D who wore a blinded CGM and recorded PRH in the Hypo-METRICS app over 10 weeks. Rates of SDH <70 mg/dL, SDH <54 mg/dL, and PRH were expressed as median episodes per week. Episodes of SDH were matched to episodes of PRH that occurred within 1 h.

RESULTS

Median [interquartile range] rates of hypoglycemia were significantly higher in T1D versus T2D; for SDH <70 mg/dL (6.5 [3.8-10.4] vs. 2.1 [0.8-4.0]), SDH <54 mg/dL (1.2 [0.4-2.5] vs. 0.2 [0.0-0.5]), and PRH (3.9 [2.4-5.9] vs. 1.1 [0.5-2.0]). Overall, 65% of SDH <70 mg/dL was not associated with PRH, and 43% of PRH had no associated SDH. The median proportion of SDH associated with PRH in T1D was higher for SDH <70 mg/dL (40% vs. 22%) and SDH <54 mg/dL (47% vs. 25%) than in T2D.

CONCLUSIONS

The novel findings are that at least half of CGM hypoglycemia is asymptomatic, even below 54 mg/dL, and many reported symptomatic hypoglycemia episodes happen above 70 mg/dL. In the clinical and research setting, these episodes cannot be used interchangeably, and both need to be recorded and addressed.

Original language	English
Pages (from-to)	1769-1777
Number of pages	9
Journal	Diabetes Care
Volume	47
Issue number	10
DOIs	https://doi.org/10.2337/dc23-2332
Publication status	Published - Oct 2024

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Advanced and Specialised Nursing

Access to Document

10.2337/dc23-2332

Author Accepted ManuscriptAccepted author manuscript, 601 KBLicence: CC BY

Hypoglycaemia - REdefining SOLutions for better liVEs (Hypo-RESOLVE) (Joint with Stichting Katholieke Universiteit, King's College London, Medizinische Universitat Graz and 19 others)
McCrimmon, R. (Investigator)
COMMISSION OF THE EUROPEAN COMMUNITIES
1/05/18 → 1/11/23
Project: Research

Cite this

Hypo-RESOLVE Consortium, Divilly, P., Martine-Edith, G., Zaremba, N., Søholm, U., Mahmoudi, Z., Cigler, M., Ali, N., Abbink, E. J., Brøsen, J., de Galan, B., Pedersen-Bjergaard, U., Vaag, A. A., McCrimmon, R. J., Renard, E., Heller, S., Evans, M., Mader, J. K., Amiel, S. A., ... Choudhary, P. (2024). Relationship Between Sensor-Detected Hypoglycemia and Patient-Reported Hypoglycemia in People With Type 1 and Insulin-Treated Type 2 Diabetes: The Hypo-METRICS Study. Diabetes Care, 47(10), 1769-1777. https://doi.org/10.2337/dc23-2332

@article{1a9ed848f23f4a3d93f47fe4d6ae66cd,

title = "Relationship Between Sensor-Detected Hypoglycemia and Patient-Reported Hypoglycemia in People With Type 1 and Insulin-Treated Type 2 Diabetes: The Hypo-METRICS Study",

abstract = "OBJECTIVE Use of continuous glucose monitoring (CGM) has led to greater detection of hypoglycemia; the clinical significance of this is not fully understood. The Hypoglycaemia-Measurement, Thresholds and Impacts (Hypo-METRICS) study was designed to investigate the rates and duration of sensor-detected hypoglycemia (SDH) and their relationship with person-reported hypoglycemia (PRH) in people living with type 1 diabetes (T1D) and insulin-treated type 2 diabetes (T2D) with prior experience of hypoglycemia. RESEARCH DESIGN AND METHODS We recruited 276 participants with T1D and 321 with T2D who wore a blinded CGM and recorded PRH in the Hypo-METRICS app over 10 weeks. Rates of SDH <70 mg/dL, SDH <54 mg/dL, and PRH were expressed as median episodes per week. Episodes of SDH were matched to episodes of PRH that occurred within 1 h. RESULTS Median [interquartile range] rates of hypoglycemia were significantly higher in T1D versus T2D; for SDH <70 mg/dL (6.5 [3.8-10.4] vs. 2.1 [0.8-4.0]), SDH <54 mg/dL (1.2 [0.4-2.5] vs. 0.2 [0.0-0.5]), and PRH (3.9 [2.4-5.9] vs. 1.1 [0.5-2.0]). Overall, 65\% of SDH <70 mg/dL was not associated with PRH, and 43\% of PRH had no associated SDH. The median proportion of SDH associated with PRH in T1D was higher for SDH <70 mg/dL (40\% vs. 22\%) and SDH <54 mg/dL (47\% vs. 25\%) than in T2D. CONCLUSIONSThe novel findings are that at least half of CGM hypoglycemia is asymptomatic, even below 54 mg/dL, and many reported symptomatic hypoglycemia episodes happen above 70 mg/dL. In the clinical and research setting, these episodes cannot be used interchangeably, and both need to be recorded and addressed.",

author = "\{Hypo-RESOLVE Consortium\} and Patrick Divilly and Gilberte Martine-Edith and Natalie Zaremba and Uffe S{\o}holm and Zeinab Mahmoudi and Monika Cigler and Namam Ali and Abbink, \{Evertine J.\} and Julie Br{\o}sen and \{de Galan\}, Bastiaan and Ulrik Pedersen-Bjergaard and Vaag, \{Allan A.\} and McCrimmon, \{Rory J.\} and Eric Renard and Simon Heller and Mark Evans and Mader, \{Julia K.\} and Amiel, \{Stephanie A.\} and Frans Pouwer and Pratik Choudhary",

note = "Publisher Copyright: {\textcopyright} 2024 by the American Diabetes Association.",

year = "2024",

month = oct,

doi = "10.2337/dc23-2332",

language = "English",

volume = "47",

pages = "1769--1777",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "10",

}

Hypo-RESOLVE Consortium, Divilly, P, Martine-Edith, G, Zaremba, N, Søholm, U, Mahmoudi, Z, Cigler, M, Ali, N, Abbink, EJ, Brøsen, J, de Galan, B, Pedersen-Bjergaard, U, Vaag, AA, McCrimmon, RJ, Renard, E, Heller, S, Evans, M, Mader, JK, Amiel, SA, Pouwer, F & Choudhary, P 2024, 'Relationship Between Sensor-Detected Hypoglycemia and Patient-Reported Hypoglycemia in People With Type 1 and Insulin-Treated Type 2 Diabetes: The Hypo-METRICS Study', Diabetes Care, vol. 47, no. 10, pp. 1769-1777. https://doi.org/10.2337/dc23-2332

Relationship Between Sensor-Detected Hypoglycemia and Patient-Reported Hypoglycemia in People With Type 1 and Insulin-Treated Type 2 Diabetes: The Hypo-METRICS Study. / Hypo-RESOLVE Consortium; Divilly, Patrick (Lead / Corresponding author); Martine-Edith, Gilberte et al.
In: Diabetes Care, Vol. 47, No. 10, 10.2024, p. 1769-1777.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Relationship Between Sensor-Detected Hypoglycemia and Patient-Reported Hypoglycemia in People With Type 1 and Insulin-Treated Type 2 Diabetes

T2 - The Hypo-METRICS Study

AU - Hypo-RESOLVE Consortium

AU - Divilly, Patrick

AU - Martine-Edith, Gilberte

AU - Zaremba, Natalie

AU - Søholm, Uffe

AU - Mahmoudi, Zeinab

AU - Cigler, Monika

AU - Ali, Namam

AU - Abbink, Evertine J.

AU - Brøsen, Julie

AU - de Galan, Bastiaan

AU - Pedersen-Bjergaard, Ulrik

AU - Vaag, Allan A.

AU - McCrimmon, Rory J.

AU - Renard, Eric

AU - Heller, Simon

AU - Evans, Mark

AU - Mader, Julia K.

AU - Amiel, Stephanie A.

AU - Pouwer, Frans

AU - Choudhary, Pratik

PY - 2024/10

Y1 - 2024/10

N2 - OBJECTIVE Use of continuous glucose monitoring (CGM) has led to greater detection of hypoglycemia; the clinical significance of this is not fully understood. The Hypoglycaemia-Measurement, Thresholds and Impacts (Hypo-METRICS) study was designed to investigate the rates and duration of sensor-detected hypoglycemia (SDH) and their relationship with person-reported hypoglycemia (PRH) in people living with type 1 diabetes (T1D) and insulin-treated type 2 diabetes (T2D) with prior experience of hypoglycemia. RESEARCH DESIGN AND METHODS We recruited 276 participants with T1D and 321 with T2D who wore a blinded CGM and recorded PRH in the Hypo-METRICS app over 10 weeks. Rates of SDH <70 mg/dL, SDH <54 mg/dL, and PRH were expressed as median episodes per week. Episodes of SDH were matched to episodes of PRH that occurred within 1 h. RESULTS Median [interquartile range] rates of hypoglycemia were significantly higher in T1D versus T2D; for SDH <70 mg/dL (6.5 [3.8-10.4] vs. 2.1 [0.8-4.0]), SDH <54 mg/dL (1.2 [0.4-2.5] vs. 0.2 [0.0-0.5]), and PRH (3.9 [2.4-5.9] vs. 1.1 [0.5-2.0]). Overall, 65% of SDH <70 mg/dL was not associated with PRH, and 43% of PRH had no associated SDH. The median proportion of SDH associated with PRH in T1D was higher for SDH <70 mg/dL (40% vs. 22%) and SDH <54 mg/dL (47% vs. 25%) than in T2D. CONCLUSIONSThe novel findings are that at least half of CGM hypoglycemia is asymptomatic, even below 54 mg/dL, and many reported symptomatic hypoglycemia episodes happen above 70 mg/dL. In the clinical and research setting, these episodes cannot be used interchangeably, and both need to be recorded and addressed.

AB - OBJECTIVE Use of continuous glucose monitoring (CGM) has led to greater detection of hypoglycemia; the clinical significance of this is not fully understood. The Hypoglycaemia-Measurement, Thresholds and Impacts (Hypo-METRICS) study was designed to investigate the rates and duration of sensor-detected hypoglycemia (SDH) and their relationship with person-reported hypoglycemia (PRH) in people living with type 1 diabetes (T1D) and insulin-treated type 2 diabetes (T2D) with prior experience of hypoglycemia. RESEARCH DESIGN AND METHODS We recruited 276 participants with T1D and 321 with T2D who wore a blinded CGM and recorded PRH in the Hypo-METRICS app over 10 weeks. Rates of SDH <70 mg/dL, SDH <54 mg/dL, and PRH were expressed as median episodes per week. Episodes of SDH were matched to episodes of PRH that occurred within 1 h. RESULTS Median [interquartile range] rates of hypoglycemia were significantly higher in T1D versus T2D; for SDH <70 mg/dL (6.5 [3.8-10.4] vs. 2.1 [0.8-4.0]), SDH <54 mg/dL (1.2 [0.4-2.5] vs. 0.2 [0.0-0.5]), and PRH (3.9 [2.4-5.9] vs. 1.1 [0.5-2.0]). Overall, 65% of SDH <70 mg/dL was not associated with PRH, and 43% of PRH had no associated SDH. The median proportion of SDH associated with PRH in T1D was higher for SDH <70 mg/dL (40% vs. 22%) and SDH <54 mg/dL (47% vs. 25%) than in T2D. CONCLUSIONSThe novel findings are that at least half of CGM hypoglycemia is asymptomatic, even below 54 mg/dL, and many reported symptomatic hypoglycemia episodes happen above 70 mg/dL. In the clinical and research setting, these episodes cannot be used interchangeably, and both need to be recorded and addressed.

U2 - 10.2337/dc23-2332

DO - 10.2337/dc23-2332

M3 - Article

C2 - 39207738

AN - SCOPUS:85204660830

SN - 0149-5992

VL - 47

SP - 1769

EP - 1777

JO - Diabetes Care

JF - Diabetes Care

IS - 10

ER -

Relationship Between Sensor-Detected Hypoglycemia and Patient-Reported Hypoglycemia in People With Type 1 and Insulin-Treated Type 2 Diabetes: The Hypo-METRICS Study

Abstract

UN SDGs

ASJC Scopus subject areas

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Projects

Hypoglycaemia - REdefining SOLutions for better liVEs (Hypo-RESOLVE) (Joint with Stichting Katholieke Universiteit, King's College London, Medizinische Universitat Graz and 19 others)

Cite this