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Cited by 82Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

Hypoglycemia unawareness and autonomic dysfunction in diabetes: Lessons learned and roles of diabetes technologies

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Lin, Yu Kuei, Fisher, Simon J, Pop‐Busui, Rodica·2020·Journal of Diabetes Investigation
DOI 10.1111/jdi.13290PMC PMC7610104
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Abstract

Impaired awareness of hypoglycemia (IAH) is a reduction in the ability to recognize low blood glucose levels that would otherwise prompt an appropriate corrective therapy. Identified in approximately 25% of patients with type 1 diabetes, IAH has complex pathophysiology, and might lead to serious and potentially lethal consequences in patients with diabetes, particularly in those with more advanced disease and comorbidities. Continuous glucose monitoring systems can provide real‐time glucose information and generate timely alerts on rapidly falling or low blood glucose levels. Given their improvements in accuracy, affordability and integration with insulin pump technology, continuous glucose monitoring systems are emerging as critical tools to help prevent serious hypoglycemia and mitigate its consequences in patients with diabetes. This review discusses the current knowledge on IAH and effective diagnostic methods, the relationship between hypoglycemia and cardiovascular autonomic neuropathy, a practical approach to evaluating cardiovascular autonomic neuropathy for clinicians, and recent evidence from clinical trials assessing the effects of the use of CGM technologies in patients with type 1 diabetes with IAH.

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Cited by

Sorted by citations

Authors
Lin, Y. K., Fisher, S. J., & Pop‐Busui, R.
Affiliations
  • University of Michigan (US)
  • University of Utah (US)
Corresponding author
Pop‐Busui, Rodica
ORCID
Venue
Journal of Diabetes Investigation
Publisher
Wiley
Published
2020-07-07
Volume
11
Issue
6
Pages
1388-1402
ISSN
  • 2040-1116 (ISSN-L)
  • 2040-1124
DOI
10.1111/jdi.13290
PMC
PMC7610104
OpenAlex
W3024689673
Cited by
82
References
37
Citations by year
2026: 6 · 2025: 14 · 2024: 21 · 2023: 17 · 2022: 10 · 2021: 13 · 2020: 1
FWCI
1.57
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Diabetes Investigation (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Juvenile Diabetes Research Foundation United States of America (Center of Excellence at the University of Michigan)
  • National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK107956‐01, R01DK118082, U01DK119083)
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
hypoglycemia unawareness, impaired awareness of hypoglycemia, type 1 diabetes, autonomic dysfunction, cardiac autonomic neuropathy, continuous glucose monitoring, insulin pump therapy, hypoglycemia prevention, hypoglycemia diagnosis
MeSH terms
Autonomic Nervous System Diseases, Diabetes Mellitus, Diabetic Neuropathies, Humans, Hypoglycemia, Health Knowledge, Attitudes, Practice, Prognosis, Risk Factors, Blood Glucose Self-Monitoring, Diabetes Complications

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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 ›

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