ArticleEndocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists2023
Validating and Establishing a Diagnostic Threshold for the Hypoglycemia Awareness Questionnaire Impaired Awareness Subscale.
Article in Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Risk factors for hypoglycaemia in adults with type 1 diabetes: a systematic review and meta-analysis.BMC endocrine disorders · 2025Pooled it
- The Impact of Hypoglycaemia on Quality of Life in Adults With Type 1 Diabetes Using Contemporary Diabetes Technologies: A US National Survey.Diabetes, obesity & metabolism · 2026Article
- Gold and Clarke Questionnaires Identify Different People With Insulin-Treated Diabetes and Impaired Awareness of Hypoglycaemia in Almost 60% of Cases: A Post Hoc Analysis From the Hypo-METRICS Study.Diabetes, obesity & metabolism · 2026Article
- Assessing thoughts, feelings and behaviours related to hypoglycaemia: Psychometric evaluation of the Hypoglycaemia Cues Questionnaire (HypoC-Q).Diabetic medicine : a journal of the British Diabetic Association · 2026Article
- Interoceptive Awareness Moderates the Relationship Between Hypoglycemia Exposure and Symptom Recognition in Adults With Type 1 Diabetes.Diabetes care · 2026Article
- Characterizing Severe and Level 2 Hypoglycemia and Associated Risk Factors in Adults with Type 1 Diabetes Using Hybrid Closed-Loop Insulin Pumps.Diabetes technology & therapeutics · 2025Article
- Impaired Awareness and Symptomatology of Hypoglycemia in Adults With Type 1 Diabetes Using Continuous Glucose Monitoring.The Journal of clinical endocrinology and metabolism · 2025Article
- Validation using item response theory, and assessment of sensitivity to change of the Hypoglycemia Awareness Questionnaire in patients with type 2 diabetes treated with insulin.Journal of diabetes investigation · 2025Article
- The challenge of assessing impaired awareness of hypoglycaemia in diabetes in the era of continuous glucose monitoring: A narrative review of evidence and translation into clinical practice.Diabetes, obesity & metabolism · 2025Review
- Characterising impaired awareness of hypoglycaemia and associated risks through HypoA-Q: findings from a T1D Exchange cohort.Diabetologia · 2025Article
- Interoceptive Awareness Is Associated With Impaired Awareness of Hypoglycemia in Adults With Type 1 Diabetes.Diabetes care · 2025Article
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6 authors.
Funding
Abstract
objectiveTo evaluate the discriminant and convergent validities of the Hypoglycemia Awareness Questionnaire Impaired Awareness (HypoA-Q IA) subscale and establish a diagnostic threshold for the classification of impaired awareness of hypoglycemia (IAH) in adults with type 1 diabetes (T1D).
methodsTwenty-one adults with T1D (male, 48%; median age, 36 years; and T1D duration, 21 years) completed the HypoA-Q IA subscale, Clarke, and hypoglycemia severity (HYPO) scores, continuous glucose monitoring, and hyperinsulinemic hypoglycemic clamp testing. Those with IAH defined by a Clarke score of ≥4 (n = 10) and who experienced severely problematic hypoglycemia and/or marked glycemic lability started automated insulin delivery as part of an 18-month intervention study with the 6-monthly paired assessment of the HypoA-Q IA subscale, Clarke score, HYPO score and continuous glucose monitoring, and hypoglycemic clamp testing at baseline and 6 and 18 months.
resultsThe HypoA-Q IA subscale discriminated between those with and without IAH defined by the Clarke score (W = 110.5; P <.001). During intervention, the HypoA-Q IA subscale demonstrated convergent validity via significant relationships with the Clarke (r = 0.72; P <.001) and HYPO (r = 0.60; P <.001) scores; hypoglycemia exposure below 70 (r = 0.53; P <.01), 60 (r = 0.50; P <.01), and 54 (r = 0.48; P <.01) mg/dL; and autonomic symptom (r = -0.53; P <.05), epinephrine (r = -0.68; P <.001), and pancreatic polypeptide (r = -0.52; P <.05) responses to insulin-induced hypoglycemia. The receiver operating characteristic curve analysis revealed that the HypoA-Q IA subscale was an excellent predictor of an abnormal symptom response to insulin-induced hypoglycemia (area under the curve, 0.86) with a score of 12, which was the optimal threshold for IAH classification (sensitivity, 83%; specificity, 80%).
conclusionThese findings support the validity of the HypoA-Q IA subscale and propose a HypoA-Q IA diagnostic threshold to identify IAH in both clinical and research settings.
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