Association of hypoglycemia problem-solving abilities with severe hypoglycemia in adults with type 1 diabetes: a Poisson regression analysis

Severe hypoglycemia (SH) poses a significant challenge in the management of type 1 diabetes (T1D); however, the factors that offer protection other than diabetes technologies are under-studied. The primary objective of this study was to examine the association between hypoglycemia problem-solving (HPS) abilities and severe hypoglycemic events in adults with T1D using Poisson regression analysis.

In this cross-sectional study, 287 adults with T1D (mean age: 50.3 ± 14.5 years, male: 36.2%, diabetes duration: 17.5 ± 11.2 years, mean HbA1c: 7.7 ± 0.9%) were included and categorized into two groups: non-SH (n = 262) and SH (n = 25). Data on diabetic complications, the hypoglycemia problem-solving scale (HPSS), and treatment details were collected. Impaired awareness of hypoglycemia (IAH) was evaluated using Gold’s method. Univariate and multivariable Poisson regression models were used for the analysis, and the findings were presented as incidence rate ratios (IRRs) at 95% confidence interval (CI).

The incidence of SH was 16.7 (95% CI 7.5–26.0) per 100 person-years. In the univariate Poisson regression analysis, findings revealed associations between IAH, diabetic peripheral neuropathy (DPN), and HPSS1. On the other hand, the multivariate Poisson regression analysis, utilizing stepwise variable selection, identified DPN (IRR: 4.65, 95% CI 1.96–11.04; P < 0.001) and HPSS1 score (IRR: 0.51, 95% CI 0.34, 0.76; P = 0.001) as factors significantly associated with SH.

We identified HPS abilities, in addition to DPN, were associated with SH in adults with T1D.

University Hospital Medical Information Network (UMIN) Center: UMIN000039475), approval date: February 13, 2020.