• Magdalena Michalak, Dorota Zozulińska-Ziółkiewicz, Michał Michalak, Aleksandra Cieluch, Mateusz Michalski, and Aleksandra Araszkiewicz.
• Pol. Arch. Med. Wewn. 2025 Feb 6.

IntroductionImpaired awareness of hypoglycemia (IAH) increases the risk of severe hypoglycemia. Questionnaires may allow for easy identification of patients with IAH and facilitate appropriate intervention.ObjectivesThis study aims to assess the clinical utility of commonly used questionnaires for diagnosing IAH, providing practical insight for medical professionals. Additionally, we seek to identify clinical factors associated with IAH in adults with type 1 diabetes (T1D), enhancing understanding of this condition in a real-world context.Patients And MethodsThe study included 252 adults with T1D (135 men) aged 41 years (IQR: 30-52). Awareness of hypoglycemia using the validated questionnaires [Clarke scale, Gold scale, and Hypoglycemia Awareness Questionnaire (HypoA-Q)], anthropometric data, and metabolic control were evaluated. To estimate the optimal cut-off point for the diagnosis of IAH using HypoA-Q, the Receiver Operating Characteristic (ROC) curve analysis was used. IAH was diagnosed by at least one abnormal questionnaire score.ResultsWe found a cut-off point of 9 points for diagnosing IAH on HypoA-Q (sensitivity of 79%, specificity of 82%, AUC = 0.898). IAH in any abnormal test was found in 98 patients (39%). In the univariable logistic regression models, the diagnosis of IAH was associated with lifetime episodes of severe hypoglycemia, hypertension, glycated hemoglobin (A1c) value, mean glycemia, standard deviation (SD), total, LDL and non-HDL cholesterol levels, and daily dose of insulin.ConclusionsThe HypoA-Q, with a 9-point cut-off, demonstrated the highest sensitivity for diagnosing IAH, and may be considered the most valuable screening tool for IAH detection.

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