Lin Yu Kuei, Ye Wen, Hepworth Emily, Ang Lynn, Amiel Stephanie A, Fisher Simon J
Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
Department of Biostatistics, University of Michigan, Ann Arbor, USA.
Diabet Med. 2025 Apr;42(4):e15513. doi: 10.1111/dme.15513. Epub 2025 Jan 11.
Several wordings of the definition of severe hypoglycaemia (SH) exist. This study aims to evaluate how different SH definition wordings affect SH history assessment.
In this cross-sectional study, surveys were emailed to registrants of the T1D Exchange, a U.S. national type 1 diabetes patient registry. Participants' demographic information was collected. Six-month SH history was evaluated with questionnaires including SH definition wordings from either (1) professional societies, (2) a diabetes community website, or (3) a hypoglycaemia research questionnaire. Analyses included the McNemar test, pairwise Wilcoxon signed-rank test, logistic regression analysis, Kappa statistics, and Spearman correlation.
A total of 1580 valid responses were obtained from participants (52% female; mean ± SD age: 46 ± 15 years; 95% White; mean ± SD diabetes duration: 25 ± 16 years). Questionnaires with four different SH definition wordings yielded significant variations in the prevalence of SH (i.e., having developed at least one episode of SH) and the number of SH episodes: the ADA/ENDO 2013 definition wording yielded the highest results on both metrics, whereas HypoA-Q and ADA 2023 yielded the lowest. Among participants reporting at least one SH episode, the number of episodes identified with the different SH definition wordings was poorly correlated (R: 0.09-0.37; p < 0.001). Race, education level, and household income were associated with higher odds of discrepancies in SH history (p < 0.05).
This U.S. national survey with individuals living with type 1 diabetes demonstrated significant discrepancies in SH history when assessed with different SH definition wordings. Race and socioeconomic status were associated with these discrepancies.
存在几种关于严重低血糖（SH）定义的表述。本研究旨在评估不同的SH定义表述如何影响SH病史评估。
在这项横断面研究中，通过电子邮件向T1D Exchange（美国一个全国性的1型糖尿病患者登记处）的登记人员发送调查问卷。收集参与者的人口统计学信息。使用包含以下来源的SH定义表述的问卷评估六个月的SH病史：（1）专业协会，（2）一个糖尿病社区网站，或（3）一份低血糖研究问卷。分析包括McNemar检验、配对Wilcoxon符号秩检验、逻辑回归分析、Kappa统计和Spearman相关性分析。
共获得1580名参与者的有效回复（52%为女性；平均±标准差年龄：46±15岁；95%为白人；平均±标准差糖尿病病程：25±16年）。采用四种不同SH定义表述的问卷在SH患病率（即至少发生过一次SH）和SH发作次数方面产生了显著差异：ADA/ENDO 2013定义表述在这两个指标上的结果最高，而HypoA-Q和ADA 2023的结果最低。在报告至少一次SH发作的参与者中，用不同SH定义表述确定的发作次数相关性较差（R：0.09 - 0.37；p < 0.001）。种族、教育水平和家庭收入与SH病史差异的较高几率相关（p < 0.05）。
这项针对美国1型糖尿病患者的全国性调查表明，使用不同的SH定义表述评估时，SH病史存在显著差异。种族和社会经济地位与这些差异相关。
