Prevalence of and factors associated with impaired awareness of hypoglycemia among hospitalized adults with diabetes: a single-center cross-sectional study

Impaired awareness of hypoglycemia (IAH) is a clinically important complication of diabetes that is associated with an increased risk of severe hypoglycemic events. However, epidemiological data on IAH in Chinese hospitalized patients remain limited. This study aimed to investigate the prevalence of IAH and identify its associated factors among hospitalized adults with diabetes. A cross-sectional survey was conducted among 390 hospitalized patients with diabetes in a tertiary hospital in Beijing (November 2025 – March 2026). IAH was assessed using the Chinese version of the Clarke questionnaire. Univariable analyses and multivariable logistic regression were performed to identify independent factors. Hierarchical three-model analysis and ROC curve were used for further evaluation. IAH prevalence was 17.44% (68/390). In the fully adjusted model (Model 3), history of severe hypoglycemia (OR = 8.37, 95% CI: 3.64–19.23, P < 0.001), practice score (OR = 0.94, 95% CI: 0.90–0.98, P = 0.010), and type 1 diabetes (OR = 4.16, 95% CI: 1.40–12.32, P = 0.010) remained independently associated with IAH. The model showed acceptable discrimination (AUC = 0.819, 95% CI: 0.759–0.879) and satisfactory calibration (Hosmer–Lemeshow P = 0.173). IAH was common among hospitalized patients with diabetes in tertiary care settings. History of severe hypoglycemia was associated with higher odds of IAH, while better hypoglycemia prevention practices were associated with lower odds of IAH. Clinicians may consider assessing awareness status in patients with a history of severe hypoglycemia. Whether behavior-centered educational strategies can improve outcomes for hospitalized patients with diabetes remains to be determined.