OBJECTIVE 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. RESEARCH DESIGN AND METHODS 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. RESULTS 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). CONCLUSIONS IAH and SH have declined substantially over two decades, reflecting improved diabetes care. However, ongoing IAH signifies the need for routine screening.
Delaney et al. (Fri,) studied this question.
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