Factors Associated With Progression From Level 1 to Level 2 Sensor-Detected Hypoglycaemia in People With Type 1 and Insulin-Treated Type 2 Diabetes: A Post Hoc Analysis From the Hypo-METRICS Study.

Authors

Vaios Koutroukas, Aikaterina Tziannou, Jonah J C Thomas, Gilberte Martine-Edith, Simon Heller, Julia K Mader, Julie Maria Bøggild Brøsen, Ulrik Pedersen-Bjergaard, Bastiaan E de Galan, Eric Renard, Mark L Evans, Rory J McCrimmon, Jane Speight, Frans Pouwer, Stephanie A Amiel, Pratik Choudhary

Published in

Diabetes, obesity & metabolism. Aug 04, 2026. Epub Aug 04, 2026.

Abstract

We investigated the proportion of sensor-detected hypoglycaemic (SDH) events progressing to level 2, and associated variables.
We used data from Hypo-METRICS, which recruited people with type 1 (pwT1D) and insulin-treated type 2 diabetes (pwT2D) with ≥ 1 hypoglycaemic event in preceding 3 months, wearing blinded continuous glucose monitoring devices (CGM), additional to usual monitoring modality, and FitBits for 10 weeks. We defined: L1: SDH < 3.9 mmol/L for ≥ 15 min but ≥ 3.0 mmol/L; L2: SDH < 3.9 mmol/L with ≥ 15 min of sensor glucose < 3.0 mmol/L; L2 ratio = L2/(L1 + L2), restricted to participants with both event types during the study period. Associations of selected variables on L2 ratio was assessed using beta regression and purposeful variable selection.
We analysed 23 768 SDH events from 212 pwT1D and 213 pwT2D. PwT1D were predominantly female (53% vs. 42% in T2D, p = 0.023) and younger (median age 49 vs. 62 years, p < 0.001), with a higher L2 ratio (16% vs. 14%, p = 0.03). Coefficient of variation (CV), OR = 1.07, 95% CI = 1.06-1.09 (p < 0.001), and mean sensor glucose, OR = 1.13, 95% CI = 1.08-1.18 (p < 0.001) were the principal predictors in T1D and T2D respectively; mean L1-SDH duration, weekly L1-SDH frequency, personal CGM usage, impaired awareness were not. Progression was higher during sleep than wakefulness (21% vs. 11%, p < 0.001); L2 ratios during sleep did not differ by awareness status.
Approximately one sixth of SDH events progressed to L2, with a higher proportion in T1D than T2D. The principal determinants were CV in T1D and mean glucose in T2D. Awareness status was not associated with progression risk during sleep.

PMID:
42552225
Bibliographic data and abstract were imported from PubMed on 05 Aug 2026.

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