Exploring Corresponding Cutpoints for Hypoglycaemia Awareness Questionnaire ( HypoA ‐Q) Impaired Awareness Subscale in Relation to the Gold and Clarke Measures: A Post Hoc Analysis From the Hypo‐ METRICS Study
Year: 2026
Type: article
Abstract: AIMS: The Hypoglycaemia Awareness Questionnaire-Impaired Awareness subscale (HypoA-Q/IA) was developed to enhance impaired awareness of hypoglycaemia (IAH) assessment, addressing methodological deficiencies of the established Gold and Clarke measures. An IAH cutpoint (HypoA-Q/IA ≥ 12) was identified from a clamp study in Type 1 diabetes (T1D). We explored cutpoints in relation to Gold and Clarke measures, and their co-occurrence, in the larger, real-world observational Hypo-METRICS study, in people with T1D (pwT1D) and insulin-treated Type 2 diabetes (pwT2D). MATERIAL AND METHODS: Hypo-METRICS recruited pwT1D or pwT2D with ≥ 1 hypoglycaemic event in the previous 3 months. IAH was defined as Gold ≥ 4, Clarke ≥ 4 and/or HypoA-Q/IA ≥ 12. Bidirectional ROC analysis was performed between HypoA-Q/IA and Gold/Clarke cutpoints. RESULTS: Questionnaires were completed by 232 pwT1D and 285 pwT2D (male 47% vs. 62%, p < 0.001; median age 49 vs. 63 years, p < 0.001; HbA1c 7.3% vs. 7.4%, p = 0.03). IAH prevalence was 24% by Gold ≥ 4, 16% by Clarke ≥ 4 and 7% by HypoA-Q/IA ≥ 12. ROC analysis yielded HypoA-Q/IA cutpoints of ≥ 7 against Gold ≥ 4 (AUC 0.87) and ≥ 9 against Clarke ≥ 4 (AUC 0.89), and cutpoints of Gold ≥ 4 (AUC 0.87) and Clarke ≥ 3 (AUC 0.93) against HypoA-Q/IA ≥ 12. Of those with IAH by either measure, 24% were identified by both HypoA-Q/IA ≥ 12 and Gold ≥ 4, and 32% by both HypoA-Q/IA ≥ 12 and Clarke ≥ 4, with lower overlap in T2D than T1D. CONCLUSIONS: HypoA-Q/IA cutpoints corresponding to legacy IAH cutpoints (≥ 7-9) were lower than the clamp-derived threshold (≥ 12), suggesting ≥ 12 may identify a subgroup with more severe IAH. These cutpoints enable cross-study comparison; prospective validation against severe hypoglycaemia risk is needed.
Source: Diabetes Obesity and Metabolism
DOI: 10.1111/dom.71504
Authors: Vaios Koutroukas, Aikaterina Tziannou, Uffe Søholm, Jonah J. C. Thomas, Gilberte Martine‐Edith, Simon Heller, Julia K. Mader, Ulrik Pedersen‐Bjergaard, Bastiaan E. de Galan, Eric Renard, Mark L. Evans, Rory McCrimmon, Frans Pouwer, Stephanie A. Amiel, James A. M. Shaw, Jane Speight, Pratik Choudhary
Institutions: University of Leicester, Cancer Research UK Clinical Trials Unit, University of Birmingham, Deakin University, Diabetes Victoria, University of Sheffield, Medical University of Graz, University of Copenhagen, Nordsjællands Hospital, Maastricht University Medical Centre, Radboud University Medical Center, Maastricht University, Centre National de la Recherche Scientifique, Inserm, Université de Montpellier, Institut de Génomique Fonctionnelle, University of Cambridge, Wellcome/MRC Institute of Metabolic Science, University of Dundee, Steno Diabetes Centers, University of Southern Denmark, Western Norway University of Applied Sciences, King's College London, Newcastle University
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,380
OpenAlex ID: W7225169437