Incidence and risk factors for severe and symptomatic hypoglycemia in type 1 diabetes. Results of the HYPOS-1 study
Abstract
Objective Hypoglycemia is common in type 1 diabetes mellitus (T1DM). We aimed to update the incidence of severe and symptomatic hypoglycemia and investigate several correlated factors.Methods In this multicenter, observational retrospective study, the data of 206 T1DM patients from a sample of 2,229 consecutive patients seen at 18 diabetes clinics were analyzed. Sociodemographic and clinical characteristics, severe hypoglycemia in the past 12 months, and symptomatic hypoglycemia in the past 4 weeks were recorded with a self-report questionnaire and a clinical form during a routine visit. Poisson multivariate models were applied.Results A minority of patients accounted for the majority of both severe and symptomatic episodes. The incidence rate (IR) of severe hypoglycemia was 0.49 (0.40-0.60) events/person-years. The incidence rate ratio (IRR) was higher in patients with previous severe hypoglycemia (3.71; 2.28-6.04), neuropathy (4.16; 2.14-8.05), long duration (>20 years, 2.96; 1.60-5.45), and on polypharmacy (1.24; 1.13-1.36), but it was lower when a complication was present. The IR of symptomatic hypoglycemia was 53.3 events/person-years, with an IRR significantly higher among women or patients with better education, or shorter duration or on pumps. The IRR was lower in patients with higher BMI or neuropathy or aged more than 50 years.Conclusions Fewer than 20 % of T1DM patients are free from hypoglycemia, with one in six having experienced at least one severe episode in the last year. The distribution is uneven, with a tendency of episodes to cluster in some patients. Severe and symptomatic episodes have different correlates and reflect different conditions.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Older and/or high-risk individuals with diabetes are at notably higher risk for severe hypoglycemia due to age, duration of diabetes, duration of insulin therapy, and greater prevalence of hypoglycemia unawareness.
“Older and/or high-risk individuals with diabetes are at notably higher risk for severe hypoglycemia due to age, duration of diabetes, duration of insulin therapy, and greater prevalence of hypoglycemia unawareness (54-58).”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [54]
Older and/or high-risk individuals with diabetes are at elevated risk for hypoglycemia.
“Although there is no evidence regarding time in range for older and/or high-risk individuals, numerous studies have shown the elevated risk for hypoglycemia in these populations (54-59).”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [54]
Cites
A New Equation to Estimate Glomerular Filtration Rate
Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. (., Castro, A. F., Feldman, H. I., Kusek, J. W., Eggers, P., Van Lente, F., Greene, T., et al. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-150-9-200905050-00006 · Cited by 25,603 · see citing works
(1993) · New England Journal of Medicine · doi:10.1056/nejm199309303291401 · Cited by 24,667 · see citing works
Seaquist, E. R., Anderson, J., Childs, B., Cryer, P., Dagogo-Jack, S., Fish, L., Heller, S. R., Rodriguez, H., Rosenzweig, J., & Vigersky, R. (2013) · Diabetes Care · doi:10.2337/dc12-2480 · Cited by 1,389 · see citing works
Risk of hypoglycaemia in types 1 and 2 diabetes: Effects of treatment modalities and their duration
UK Hypoglycaemia Study Group (2007) · Diabetologia · doi:10.1007/s00125-007-0599-y · Cited by 825 · see citing works
Epidemiology of severe hypoglycemia in the diabetes control and complications trial
(1991) · The American Journal of Medicine · doi:10.1016/0002-9343(91)80085-z · Cited by 807 · see citing works
Hypoglycemia in the Diabetes Control and Complications Trial
The Diabetes Control and Complications Trial Research Group (1997) · Diabetes · doi:10.2337/diab.46.2.271 · Cited by 746 · see citing works
The barrier of hypoglycemia in diabetes
Cryer, P. E. (2008) · Diabetes · doi:10.2337/db08-1084 · Cited by 725 · see citing works
Threshold-based insulin-pump interruption for reduction of hypoglycemia
Bergenstal, R. M., Klonoff, D. C., Garg, S. K., Bode, B. W., Meredith, M., Slover, R. H., Ahmann, A. J., Welsh, J. B., Lee, S. W., & Kaufman, F. R. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1303576 · Cited by 652 · see citing works
Donnelly, L. A., Morris, A. D., Frier, B. M., Ellis, J. D., Donnan, P. T., Durrant, R., Band, M. M., Reekie, G., & Leese, G. P. (2005) · Diabetic Medicine · doi:10.1111/j.1464-5491.2005.01501.x · Cited by 511 · see citing works
The effect of continuous glucose monitoring in well-controlled type 1 diabetes
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group (2009) · Diabetes Care · doi:10.2337/dc09-0108 · Cited by 399 · see citing works
Symptoms of hypoglycaemia in people with diabetes
McAulay, V., Deary, I. J., & Frier, B. M. (2001) · Diabetic Medicine · doi:10.1046/j.1464-5491.2001.00620.x · Cited by 264 · see citing works
Recall of severe hypoglycaemia and self‐estimated state of awareness in type 1 diabetes
Pedersen‐Bjergaard, U., Pramming, S., & Thorsteinsson, B. (2003) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.377 · Cited by 240 · cited 1× · see citing works
“These time intervals were chosen according to the ability of type 1 patients to recall such episodes as ascertained in previous studies [8].”
MethodKilpatrick, E. S., Rigby, A. S., Goode, K. M., & Atkin, S. L. (2007) · Diabetologia · doi:10.1007/s00125-007-0820-z · Cited by 208 · see citing works
Hypoglycemia in Type 1 and Type 2 Diabetes: Physiology, Pathophysiology,and Management
Briscoe, V. J., & Davis, S. N. (2006) · Clinical Diabetes · doi:10.2337/diaclin.24.3.115 · Cited by 173 · see citing works
Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia.
ter Braak, E. W. M. T., Appelman, A. M. M. F., van der Laak, M. F., Stolk, R. P., van Haeften, T. W., & Erkelens, D. W. (2000) · Diabetes Care · doi:10.2337/diacare.23.10.1467 · Cited by 163 · see citing works
Hepburn, D. A., MacLeod, K. M., Pell, A. C. H., Scougal, I. J., & Frier, B. M. (1993) · Diabetic Medicine · doi:10.1111/j.1464-5491.1993.tb00050.x · Cited by 155 · see citing works
Gender differences in counterregulation to hypoglycaemia
Amiel, S. A., Maran, A., Powrie, J. K., Umpleby, A. M., & Macdonald, I. A. (1993) · Diabetologia · doi:10.1007/bf00402284 · Cited by 113 · see citing works
Pedersen‐Bjergaard, U., Kristensen, P. L., Beck‐Nielsen, H., Nørgaard, K., Perrild, H., Christiansen, J. S., Jensen, T. J., Hougaard, P., Parving, H., Thorsteinsson, B., et al. (2014) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(14)70073-7 · Cited by 94 · see citing works
Sartore, G., Chilelli, N. C., Burlina, S., Stefano, P. D., Piarulli, F., Fedele, D., Mosca, A., & Lapolla, A. (2012) · Acta Diabetologica · doi:10.1007/s00592-012-0391-4 · Cited by 90 · see citing works
Gender influences counterregulatory hormone responses to hypoglycemia
Diamond, M. P., Jones, T. W., Caprio, S., Hallarman, L., Connolly-Diamond, M., Addabbo, M., Tamborlane, W. V., & Sherwin, R. S. (1993) · Metabolism · doi:10.1016/0026-0495(93)90152-e · Cited by 78 · see citing works
Hypoglycemic counterregulatory responses differ between men and women with type 1 diabetes.
Davis, S. N., Fowler, S. P., & Costa, F. (2000) · Diabetes · doi:10.2337/diabetes.49.1.65 · Cited by 76 · see citing works
Estrogen Blunts Neuroendocrine and Metabolic Responses to Hypoglycemia
Sandoval, D. A., Ertl, A. C., Richardson, M. A., Tate, D. B., & Davis, S. N. (2003) · Diabetes · doi:10.2337/diabetes.52.7.1749 · Cited by 75 · see citing works
Incidence and Correlates of Hypoglycemia in Type 2 Diabetes. The Hypos-1 Study
Ozzello, C. B. G. A. (2014) · Journal of Diabetes & Metabolism · doi:10.4172/2155-6156.1000344 · Cited by 27 · see citing works
Cherubini, V., Pintaudi, B., Rossi, M. C., Lucisano, G., Pellegrini, F., Chiumello, G., Frongia, A. P., Monciotti, C., Patera, I. P., Toni, S., et al. (2013) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2013.11.004 · Cited by 26 · see citing works
Davis, S. N., Goldstein, R. E., Price, L., Jacobs, J. K., & Cherrington, A. D. (1993) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.77.5.8077324 · Cited by 19 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Battelino, T., Danne, T., Bergenstal, R. M., Amiel, S. A., Beck, R., Biester, T., Bosi, E., Buckingham, B. A., Cefalu, W. T., Close, K. L., et al. (2019) · Diabetes Care · doi:10.2337/dci19-0028 · Cited by 4,032 · see citing works
Grunberger, G., Sherr, J., Allende, M., Blevins, T., Bode, B., Handelsman, Y., Hellman, R., Lajara, R., Roberts, V. L., Rodbard, D., et al. (2021) · Endocrine Practice · doi:10.1016/j.eprac.2021.04.008 · Cited by 288 · see citing works
ElSayed, N. A., McCoy, R. G., Aleppo, G., Bajaj, M. S., Balapattabi, K., Beverly, E. A., Early, K. B., Bruemmer, D., Cusi, K. J., Echouffo-Tcheugui, J. B., et al. (2024) · Diabetes Care · doi:10.2337/dc25-s004 · Cited by 222 · see citing works
ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Cusi, K. J., Ekhlaspour, L., Fleming, T. K., Hilliard, M. E., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc24-s004 · Cited by 167 · see citing works
Rossi, M. C., Nicolucci, A., Ozzello, A., Gentile, S., Aglialoro, A., Chiambretti, A., Baccetti, F., Gentile, F. M., Romeo, F., Lucisano, G., et al. (2019) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2019.04.009 · Cited by 132 · see citing works
Aleppo, G., Laffel, L. M., Ahmann, A., Hirsch, I. B., Kruger, D. F., Peters, A. L., Weinstock, R. S., & Harris, D. R. (2017) · Journal of the Endocrine Society · doi:10.1210/js.2017-00388 · Cited by 124 · see citing works
Pettus, J., & Edelman, S. V. (2016) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816663747 · Cited by 120 · see citing works
Approach to Using Trend Arrows in the FreeStyle Libre Flash Glucose Monitoring Systems in Adults
Kudva, Y. C., Ahmann, A., Bergenstal, R. M., Gavin, J. R., Kruger, D. F., Midyett, L. K., Miller, E. M., & Harris, D. R. (2018) · Journal of the Endocrine Society · doi:10.1210/js.2018-00294 · Cited by 99 · see citing works
Seidu, S., Kunutsor, S. K., Topsever, P., Hambling, C. E., Cos, F. X., & Khunti, K. (2019) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.13724 · Cited by 97 · see citing works
Management of diabetes in older adults
Sesti, G., Incalzi, R. A., Bonora, E., Consoli, A., Giaccari, A., Maggi, S., Paolisso, G., Purrello, F., Vendemiale, G., & Ferrara, N. (2017) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2017.11.007 · Cited by 89 · see citing works
Bajaj, M. S., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Early, K. B., ChallaSivaKanaka, S., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc26-s004 · Cited by 86 · see citing works
Amiel, S. A., Potts, L., Goldsmith, K., Jacob, P., Smith, E. L., Gonder-Frederick, L., Heller, S., Toschi, E., Brooks, A., Kariyawasam, D., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-29488-x · Cited by 61 · see citing works
Jun, J. E., Lee, S., Lee, Y., Ahn, J. Y., Kim, G., Hur, K. Y., Lee, M., Jin, S., & Kim, J. H. (2018) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3092 · Cited by 57 · see citing works
Jensen, M. H., Dethlefsen, C., Vestergaard, P., & Hejlesen, O. K. (2019) · Journal of Diabetes Science and Technology · doi:10.1177/1932296819868727 · Cited by 56 · see citing works
Wilmot, E. G., Lumb, A. N., Hammond, P. J., Murphy, H. R., SCOTT, E. M., Gibb, F. W., Platts, J. K., & Choudhary, P. (2020) · Diabetic Medicine · doi:10.1111/dme.14433 · Cited by 53 · see citing works
Rethinking the Viability and Utility of Inhaled Insulin in Clinical Practice
Heinemann, L., & Parkin, C. G. (2018) · Journal of Diabetes Research · doi:10.1155/2018/4568903 · Cited by 48 · see citing works
Reporting Severe Hypoglycemia in Type 1 Diabetes: Facts and Pitfalls
Pedersen‐Bjergaard, U., & Thorsteinsson, B. (2017) · Current Diabetes Reports · doi:10.1007/s11892-017-0965-1 · Cited by 48 · see citing works
Chu, Y.-W., Lin, H.-M., Wang, J.-J., Weng, S., Lin, C., & Chien, C.-C. (2017) · PLoS ONE · doi:10.1371/journal.pone.0174601 · Cited by 44 · see citing works
Hypoglycaemia unawareness in patients with type 1 diabetes
Szadkowska, A., Czyżewska, K., Pietrzak, I., Mianowska, B., Jarosz-Chobot, P. A., & Myśliwiec, M. (2018) · Pediatric Endocrinology Diabetes and Metabolism · doi:10.5114/pedm.2018.80994 · Cited by 41 · see citing works
Giorda, C. B., Rossi, M. C., Ozzello, O., Gentile, S., Aglialoro, A., Chiambretti, A., Baccetti, F., Gentile, F. M., Romeo, F., Lucisano, G., et al. (2016) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2016.10.005 · Cited by 41 · see citing works
Bronstone, A. B., & Graham, C. (2016) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816633233 · Cited by 39 · see citing works
Lucidi, P., Porcellati, F., Bolli, G. B., & Fanelli, C. G. (2018) · Current Diabetes Reports · doi:10.1007/s11892-018-1065-6 · Cited by 38 · see citing works
Galindo, R. J., Parkin, C. G., Aleppo, G., Carlson, A. L., Kruger, D. F., Levy, C. J., Umpierrez, G. E., & McGill, J. B. (2021) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2021.0107 · Cited by 36 · see citing works
Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity
Yeh, C. C., Spaggiari, M., Tzvetanov, I. G., & Oberholzer, J. (2017) · Medicine · doi:10.1097/md.0000000000005847 · Cited by 31 · see citing works
Agesen, R. M., Kristensen, P. L., Beck‐Nielsen, H., Nørgaard, K., Perrild, H., Christiansen, J. S., Jensen, T., Hougaard, P., Parving, H. ‐., Thorsteinsson, B., et al. (2016) · Diabetes & Metabolism · doi:10.1016/j.diabet.2016.03.001 · Cited by 30 · see citing works
Ishtiak‐Ahmed, K., Carstensen, B., Pedersen‐Bjergaard, U., & Jørgensen, M. E. (2016) · Diabetes Care · doi:10.2337/dc16-0862 · Cited by 29 · see citing works
Adolfsson, P., Rentoul, D., Klinkenbijl, B., & Parkin, C. G. (2018) · touchREVIEWS in Endocrinology · doi:10.17925/ee.2018.14.2.50 · Cited by 29 · see citing works
Unexplained Hypoglycaemia and Large Glycaemic Variability: Skin Lipohypertrophy as a Predictive Sign
Strollo, F., Guarino, G., Armentano, V., Clemente, G., Martedì, E., Riu, S. D., Gaeta, I., Corigliano, G., Ceriello, A., & Gentile, S. (2016) · Diabetes Research - Open Journal · doi:10.17140/droj-2-126 · Cited by 28 · see citing works
Kruger, D. F., & Anderson, J. E. (2021) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2021.0193 · Cited by 24 · see citing works
Vinik, A. I., Camacho, P. M., Davidson, J. A., Handelsman, Y., Lando, H. M., Leddy, A. L., Reddy, S. K., Cook, R., Spallone, V., Tesfaye, S. H., et al. (2017) · Endocrine Practice · doi:10.4158/ep-2017-0053 · Cited by 24 · see citing works
Utilizing continuous glucose monitoring in primary care practice: What the numbers mean
Edelman, S. V., Cavaiola, T. S., BOEDER, S. C., & Pettus, J. (2020) · Primary care diabetes · doi:10.1016/j.pcd.2020.10.013 · Cited by 25 · see citing works
Reduction in Postprandial Peak Glucose With Increased Technosphere Insulin Dosage
Kaiserman, K. B., Christiansen, M. P., Bhavsar, S., Ulloa, J., Santogatta, B., Hanna, J., & Bailey, T. S. (2022) · Journal of Diabetes Science and Technology · doi:10.1177/19322968221110622 · Cited by 22 · see citing works
Gentile, S., Strollo, F., Satta, E., Corte, T. D., Romano, C., & Guarino, G. (2019) · Diabetes Therapy · doi:10.1007/s13300-019-0650-2 · Cited by 23 · see citing works
Assessment of Glucose Monitoring Adherence in Medicare Beneficiaries with Insulin-Treated Diabetes
Puckrein, G. A., Hirsch, I. B., Parkin, C. G., Taylor, B. T., Norman, G. J., Xu, L., & Marrero, D. G. (2022) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2022.0377 · Cited by 21 · see citing works
Recommendations for Initiating Use of Afrezza Inhaled Insulin in Individuals with Type 1 Diabetes
Pettus, J., Cavaiola, T. S., & Edelman, S. V. (2018) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2017.0463 · Cited by 20 · see citing works
A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes
Anderbro, T., Amsberg, S., Moberg, E., Gonder-Frederick, L. A., Adamson, U., LINS, P.-E. S., & Johansson, U. (2018) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.13 · Cited by 20 · see citing works
Lipohypertrophy in Elderly Insulin-Treated Patients With Type 2 Diabetes
the AMD-OSDI Study Group on Injection Techniques, Gentile, S., Guarino, G., Corte, T. D., Marino, G., Fusco, A., Corigliano, G., Colarusso, S., Piscopo, M., Improta, M. R., et al. (2020) · Diabetes Therapy · doi:10.1007/s13300-020-00954-3 · Cited by 21 · see citing works
Meng, G., Gu, J., Liew, S. Y., Cao, J., Wang, Z., Ma, C., Fu, Z., Zhou, H., Wang, J., Wang, S., et al. (2025) · Cell stem cell · doi:10.1016/j.stem.2025.07.006 · Cited by 20 · see citing works
Evolving Use of Continuous Glucose Monitoring Beyond Intensive Insulin Treatment
Wright, E. E., & Subramanian, S. (2021) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2021.0191 · Cited by 19 · see citing works
Paiement, K., Frenette, V., Wu, Z., Suppère, C., Messier, V., Lasalle-Vaillancourt, A., Mathieu, M.-E., & RABASA-LHORET, R. P. R. (2022) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2022.02.009 · Cited by 19 · see citing works
Takagi, S., Miura, J., Takita, M., Mochizuki, S., Asanuma, T., Hoshina, S., Takaike, H., Uchigata, Y., & Babazono, T. (2022) · Journal of Diabetes Investigation · doi:10.1111/jdi.13886 · Cited by 19 · see citing works
Chien, A., THANASEKARAN, S., Gaetano, A., IM, G. H., Wherry, K., MacLeod, J., & Vigersky, R. A. (2023) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2023.22283 · Cited by 18 · see citing works
Pathophysiology and management of hypoglycemia in diabetes
RANGEL, E. S., Deajon-Jackson, J. D., & Hwang, J. J. (2022) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.14904 · Cited by 18 · see citing works
Economic Burden of Hypoglycemia in Patients with Type 2 Diabetes Mellitus from Korea
Kim, G., Lee, Y., Han, M. H., Lee, E., Kim, C. H., Kwon, H., Jeong, I., Kang, E. S., & Kim, D. J. (2016) · PLoS ONE · doi:10.1371/journal.pone.0151282 · Cited by 17 · see citing works
Gu, W., Ren, Y., Ji, L., Hong, T., Mu, Y., Guo, L., Li, Q., Tian, Q., & Yang, X. (2015) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2015.12.024 · Cited by 15 · see citing works
Wang, H., Donnan, P. T., Leese, C. J., Duncan, E., Fitzpatrick, D., Frier, B. M., & Leese, G. (2017) · Clinical Diabetes and Endocrinology · doi:10.1186/s40842-017-0045-0 · Cited by 15 · see citing works
Cahn, A., Raz, I., Mosenzon, O., Leibowitz, G., Yanuv, I., Rozenberg, A., Iqbal, N., Hirshberg, B., Sjöstrand, M., Stahre, C., et al. (2016) · Diabetes Care · doi:10.2337/dc15-2763 · Cited by 14 · see citing works
Diabetes: how to manage patients experiencing hypoglycaemia
Lowe, R. N., Williams, B., & Claus, L. W. (2022) · Drugs in Context · doi:10.7573/dic.2021-9-11 · Cited by 18 · see citing works
Price, D. A., & Walker, T. C. (2016) · touchREVIEWS in Endocrinology · doi:10.17925/ee.2016.12.01.24 · Cited by 15 · see citing works
Martyn-Nemeth, P. A., Duffecy, J. L., Quinn, L., Park, C., Reutrakul, S., Mihailescu, D. V., Park, M., & Penckofer, S. M. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111679 · Cited by 12 · see citing works
Porcellati, F., Mauro, S. D., Mazzieri, A., Scamporrino, A., Filippello, A., Fano, M. D., Fanelli, C. G., Purrello, F., Malaguarnera, R., & Piro, S. (2021) · Biomolecules · doi:10.3390/biom11091281 · Cited by 15 · see citing works
Parekh, W., Streeton, S. E., Baker‐Knight, J., Montagnoli, R., Nicoziani, P., & Marchesini, G. (2018) · Diabetes Therapy · doi:10.1007/s13300-018-0418-0 · Cited by 13 · see citing works
Family members: The forgotten players in the diabetes care team (the TALK-HYPO Study)
Ratzki-Leewing, A., Parvaresh Rizi, E., & Harris, S. B. (2019) · Diabetes Therapy · doi:10.1007/s13300-019-00687-y · Cited by 13 · see citing works
Aleppo, G., Parkin, C. G., Carlson, A. L., Galindo, R. J., Kruger, D. F., Levy, C. J., Umpierrez, G. E., Forlenza, G. P., & McGill, J. B. (2021) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2021.0196 · Cited by 11 · see citing works
Sakane, N., Kato, K., Hata, S., Nishimura, E., Araki, R., kouyama, K., Hatao, M., Matoba, Y., Matsushita, Y., Domichi, M., et al. (2023) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-023-01024-x · Cited by 10 · see citing works
Hospitalization for Short-Term Diabetes-Related Complications: Focus on Patients Aged over 85 Years
Martino, G. D., Giovanni, P. D., Cedrone, F., Meo, F., Scampoli, P., Romano, F., & Staniscia, T. (2021) · Healthcare · doi:10.3390/healthcare9040460 · Cited by 10 · see citing works
Lindner, L. M. E., Gontscharuk, V., Bächle, C., Castillo, K., Stahl‐Pehe, A., Tönnies, T., Yossa, R., Holl, R. W., & Rosenbauer, J. (2018) · Pediatric Diabetes · doi:10.1111/pedi.12628 · Cited by 9 · see citing works
Assessing Time Below Range as a Predictor of Severe Hypoglycemia: Insights From Six Clinical Trials
Montaser, E., Williams, C., & Shah, V. N. (2026) · Diabetes Care · doi:10.2337/dc25-2353 · Cited by 7 · see citing works
de Souza, A. B. C., Corrêa‐Giannella, M. L., Gomes, M. B., Negrato, C. A., & Nery, M. (2022) · Archives of Endocrinology and Metabolism · doi:10.20945/2359-3997000000523 · Cited by 7 · see citing works
Giannoulaki, P., Kotzakioulafi, E., Nakas, A., Kontoninas, Z., Karlafti, E., Evripidou, P., Kantartzis, K., Savopoulos, C. G., Chourdakis, M., & Didangelos, T. (2024) · Nutrients · doi:10.3390/nu16132089 · Cited by 7 · see citing works
Strollo, F., & Gentile, S. (2017) · Diabetes Therapy · doi:10.1007/s13300-017-0262-7 · Cited by 7 · see citing works
Lessons learned from an unusual case of severe hypoglycemia
Improta, M. R., Strollo, F., & Gentile, S. (2019) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2019.01.033 · Cited by 7 · see citing works
Risk factors for hypoglycaemia in adults with type 1 diabetes: a systematic review and meta-analysis
Zhang, Q. X., Zhou, H., Lin, R., Hu, L., & Zhu, X. (2025) · BMC Endocrine Disorders · doi:10.1186/s12902-025-02122-9 · Cited by 5 · see citing works
Zoubi, Y. A., Mussa, B. M., Srivastava, A., Mohammed, A. K., Abdelgadir, E., Bashier, A. M., Alawadi, F., & Abusnana, S. (2020) · Brain Sciences · doi:10.3390/brainsci11010017 · Cited by 4 · see citing works
Emergency delivery of particulate drugs by active ejection using in vivo wireless devices
Krishnan, S. R., O’Keeffe, L., Rudra, A., Gumustop, D. R., Khatib, N., Liu, C., Yang, J., Wang, A., Bochenek, M. A., Lu, Y., et al. (2025) · Nature Biomedical Engineering · doi:10.1038/s41551-025-01436-2 · Cited by 5 · see citing works
Falla autonómica asociada a hipoglucemia
Houssay, S., Recalde, M., Rey, M. G., García, C., Urdaneta, R., Huber, F., Flores, C. L. U., Domínguez, C., & Nader, E. (2021) · Revista de la Sociedad Argentina de Diabetes · doi:10.47196/diab.v55i2.473 · Cited by 4 · see citing works
Guideline Development for Medical Device Technology: Issues for Consideration
Battelino, T., Brosius, F. C., Ceriello, A., Cosentino, F., Green, J., Kellerer, M., Koob, S., Kosiborod, M., Lalic, N. M., Marx, N., et al. (2022) · Journal of Diabetes Science and Technology · doi:10.1177/19322968221093355 · Cited by 4 · see citing works
Medina, A. M. G., Parra, D., Carrillo, D. C. H., Gómez, C. M., Múñoz, Ó., Caicedo-Correa, S. M., Kerguelen, A., Hortúa, L. M. R., Pantoja, Ó. D. L., Valencia, M. A. U., et al. (2024) · Journal of Diabetes Science and Technology · doi:10.1177/19322968241232659 · Cited by 3 · see citing works
Ambaye, A. S., Mengiste, F., Demise, N., Derseh, M. T., Abebe, A., Yayehrad, A. T., & Endalifer, B. L. (2024) · Patient Preference and Adherence · doi:10.2147/ppa.s458091 · Cited by 3 · see citing works
Diabetes in the Workplace: the Hazards of Hypoglycemia
Gerbo, R., Jin, C. F., & Clark, K. (2019) · Current Diabetes Reports · doi:10.1007/s11892-019-1234-2 · Cited by 3 · see citing works
Jones, G. C., Khan, J., & Sainsbury, C. A. R. (2016) · Acta Diabetologica · doi:10.1007/s00592-016-0940-3 · Cited by 3 · see citing works
Type 2 diabetes mellitus treatment habits in a specialized care setting: the START-DIAB study
Gentile, S., START DIAB Study Group, Gentile, P. I. S., Contributing investigators: Allegra Gianclaudio Armentano Vincenzo Campione Rosa Candido Riccardo Casaldi Stefania Celletti Fabio Cimino Antonio Ciotola Miryam Corda Angelo Cordaro Gaspare Cuzari Gianfranco Daniele Pantaleo De Francesco Carmelo Desenzani Paolo D’Incau Ferruccio Fatone Saverio Ferraro Maria Antonella Floridi Francesco Saverio Caldarola Gennaro Gadaleta Galluzzo Giovanni Giorda Carlo Giordano Marco Giovannini Celestino Golia Francesco Gregorio Franco Guarino Giuseppina Ladiana Vit, Ceriello, A., Pipicelli, G., & Strollo, F. (2017) · Mediterranean Journal of Nutrition and Metabolism · doi:10.3233/mnm-17160 · Cited by 3 · see citing works
Hypoglycemia awareness and burden among hospitalized patients at high risk for hypoglycemia
Long, C., & Dungan, K. M. (2020) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2019.107521 · Cited by 3 · see citing works
Gentile, S., Guarino, G., Marino, G., & Strollo, F. (2017) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2017.02.005 · Cited by 3 · see citing works
Hannah, K. L., Nemlekar, P. M., Bushman, J. S., & Norman, G. J. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15982 · Cited by 2 · see citing works
Self-care and type 1 diabetes mellitus: systematic review of sex-related differences
Baroni, I., Arrigoni, C., Caruso, R., Magon, A., Villa, G., Manara, D. F., Ausili, D., & Dellafiore, F. (2021) · Panminerva Medica · doi:10.23736/s0031-0808.21.04134-3 · Cited by 2 · see citing works
Fanelli, C. G., Lucidi, P., Bolli, G. B., & Porcellati, F. (2019) · Endocrinology · doi:10.1007/978-3-319-27316-7_22-2 · Cited by 2 · see citing works
Hughes, A. S., CHAPMAN, K. S. M., Bispham, J. A., Dimsits, J., WEINZIMER, S. A., Wolf, W. A., & Heydarian, N. M. (2022) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2022.100310 · Cited by 2 · see citing works
ÇALIŞKAN, S. G., Hacıağaoğlu, N., Tüzün, S., Öner, C., Şimşek, E. E., & Çeti̇n, H. (2022) · Turkish Journal of Family Medicine & Primary Care · doi:10.21763/tjfmpc.1023039 · Cited by 2 · see citing works
Fadini, G. P., Giordano, C. S. D. S., Salvi, L., Nicolucci, A., & The REFLECT Italian Study Group (2020) · Diabetes Therapy · doi:10.1007/s13300-020-00936-5 · Cited by 2 · see citing works
Challenges and Management Strategies in the Nutrition of Older People with Diabetes
Farooqui, K. J., Khan, A. A., Paul, T., Sirajudeen, J., Khan, H. A., Farooqui, F. K., Ferih, K. R., Al-Yahary, H. H., Haider, F., & Elzouki, A.-N. Y. (2023) · Journal of Diabetes and Endocrine Practice · doi:10.1055/s-0043-1771201 · Cited by 1 · see citing works
Sakane, N., Kato, K., Hata, S., Nishimura, E., Araki, R., Kouyama, K., Hatao, M., Matoba, Y., Matsushita, Y., Domichi, M., et al. (2025) · Internal Medicine · doi:10.2169/internalmedicine.5688-25 · Cited by 1 · see citing works
Sakane, N., Kato, K., Hata, S., Nishimura, E., Araki, R., Kouyama, K., Hatao, M., Matoba, Y., Matsushita, Y., Domichi, M., et al. (2025) · Diabetology International · doi:10.1007/s13340-025-00846-6 · Cited by 1 · see citing works
Islet Cell or Pancreas Transplantation
Piemonti, L., Socci, C., Nano, R., Maffi, P., & Secchi, A. (2018) · Endocrinology · doi:10.1007/978-3-319-45015-5_23 · Cited by 1 · see citing works
An evaluation of recurrent hypoglycemia across Chicago, Illinois
O'Connor, C., Oh, E. H., Jackson, K., Finn, D. J., Rosenman, M. B., Molitch, M. E., Kho, A., & Wallia, A. (2020) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2020.107685 · Cited by 1 · see citing works
Fanelli, C. G., Lucidi, P., Bolli, G. B., & Porcellati, F. (2018) · Endocrinology · doi:10.1007/978-3-319-44433-8_22 · Cited by 3 · see citing works
Fanelli, C. G., Lucidi, P., Bolli, G. B., & Porcellati, F. (2020) · Endocrinology · doi:10.1007/978-3-030-36694-0_22 · Cited by 1 · see citing works
Predictors of change in hypoglycemia unawareness among patients with type 1 diabetes
Melnychuk, J., Wyne, K. L., & Dungan, K. M. (2022) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3582 · Cited by 1 · see citing works
Islet Cell or Pancreas Transplantation
Piemonti, L., Socci, C., Nano, R., Maffi, P., & Secchi, A. (2018) · Endocrinology · doi:10.1007/978-3-319-27317-4_23-1 · Cited by 2 · see citing works
Ampudia‐Blasco, F. J., Duque, N., Artime, E., Caveda, E., Spaepen, E., Díaz‐Cerezo, S., Santos, M. R., Callejo, D., & Bahillo-Curieses, P. (2023) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.451 · Cited by 1 · see citing works
Kattan, W. (2017) · Journal of International Crisis and Risk Communication Research
Ipoglicemia: implicazioni cliniche e impatto sulla salute
Porcellati, F., Lucidi, P., Bolli, G. B., & Fanelli, C. G. (2019) · L Endocrinologo · doi:10.1007/s40619-018-00511-y
Fanelli, C. G., Lucidi, P., Bolli, G. B., & Porcellati, F. (2018) · Endocrinology · doi:10.1007/978-3-319-27316-7_22-1
Hypoglycemia Detection in Diabetes
Richardson, J. M., & Shaginian, R. M. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.103137
Zimamu, L. Y., Adal, G. M., Wubet, G. M., & Shiferaw, D. A. (2024) · Journal of Community Medicine and Health Solutions · doi:10.29328/journal.jcmhs.1001045
Sakane, N., Hirota, Y., Yamamoto, A., Miura, J., Takaike, H., Hoshina, S., Toyoda, M., Saito, N., Hosoda, K., Matsubara, M., et al. (2026) · Diabetology International · doi:10.1007/s13340-025-00872-4
Boateng-Kuffour, A., Kelly, C. S., Nguyen, H. T., Chandarana, K., Chapman, K. S., Chen, L., CORNELIUS, E. M., Wolf, W. A., & Polonsky, W. H. (2026) · Advances in Therapy · doi:10.1007/s12325-026-03585-5
- Authors
- HYPOS-1 Study Group of AMD, Giorda, C. B., Ozzello, A., Gentile, S., Aglialoro, A., Chiambretti, A., Baccetti, F., Gentile, F. M., Lucisano, G., Nicolucci, A., & Rossi, M. C.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- Ospedale Policlinico San Martino (IT)
- Mario Negri Sud Foundation (IT)
- Corresponding author
- Giorda, Carlo B.
- ORCID
- Venue
- Acta Diabetologica
- Published
- 2015-02-12
- Volume
- 52
- Issue
- 5
- Pages
- 845-853
- ISSN
- 0940-5429 (ISSN-L)
- 1432-5233
- OpenAlex
- W1971061045
- Cited by
- 97
- References
- 25
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 7 · 2023: 5 · 2022: 13 · 2021: 9 · 2020: 8 · 2019: 10 · 2018: 14 · 2017: 11 · 2016: 10 · 2015: 1
- FWCI
- 10.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Acta Diabetologica (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Funders
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, hypoglycemia, severe hypoglycemia, symptomatic hypoglycemia, hypoglycemia incidence, risk factors, diabetic neuropathy, disease duration, polypharmacy, insulin pump therapy, body mass index, sex differences
- MeSH terms
- Adolescent, Adult, Aged, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Male, Middle Aged, Surveys and Questionnaires, Retrospective Studies, Risk Factors, Body Mass Index
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
