ArticleDiabetes, obesity & metabolism2023
Severe (level 3) hypoglycaemia occurrence in a real-world cohort of adults with type 1 or 2 diabetes mellitus (iNPHORM, United States).
Article in Diabetes, obesity & metabolism, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 14 citations in OpenAlex.
- 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
- Glycemic Patterns Assessed by Continuous Glucose Monitoring in People with Type 2 Diabetes Treated with Insulin Glargine 100 U/mL in Primary Care: The GPDetect Study.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2026Article
- The Trajectory of Hypoglycaemia Problem-Solving Ability in Patients With Diabetes and Its Impact on Quality of Life.Journal of clinical nursing · 2026Article
- User evaluation of the Hypo-METRICS app: A tool for real-time symptom reporting of hypoglycaemia.Diabetic medicine : a journal of the British Diabetic Association · 2026Article
- Comparative safety of sulfonylurea therapies on cardiovascular and severe hypoglycemia outcomes among adults with type 2 diabetes and moderate cardiovascular risk: a target trial emulation.BMJ open diabetes research & care · 2026Article
- Mapping the storm: a scoping review of diabetic emergencies in Africa.Frontiers in clinical diabetes and healthcare · 2026Review
- Real-world incidence and risk factors of level 3 (severe) hypoglycaemia in adults with type 1 or 2 diabetes (iNPHORM, United States).Diabetes, obesity & metabolism · 2026Article
- 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026.Diabetes care · 2026Review
- Evaluating the impact of severe hypoglycaemia definition wording on severe hypoglycaemia history assessment.Diabetic medicine : a journal of the British Diabetic Association · 2025Article
- Cost-Effectiveness of FreeStyle Libre for Glucose Self-Management Among People with Diabetes Mellitus: A Canadian Private Payer Perspective.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2025Article
- 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2025.Diabetes care · 2025Review
- Risk of Severe Hypoglycemia After Initiation of Noninsulin Glucose-Lowering Therapies in Adults With Type 2 Diabetes at Moderate Cardiovascular Disease Risk.Clinical diabetes : a publication of the American Diabetes Association · 2025Article
- Decoding the Significance of Alpha Cell Function in the Pathophysiology of Type 1 Diabetes.Cells · 2024Review
- Risk factors and prediction of hypoglycaemia using the Hypo-RESOLVE cohort: a secondary analysis of pooled data from insulin clinical trials.Diabetologia · 2024Article
- Follow up care for adults with diabetes treated for severe hypoglycemia by emergency medical Services, 2013-2019.Diabetes research and clinical practice · 2024Article
- Clinical perspectives on the frequency of hypoglycemia in treat-to-target randomized controlled trials comparing basal insulin analogs in type 2 diabetes: a narrative review.BMJ open diabetes research & care · 2024Review
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Authors and funding
8 authors at 2 institutions in 2 countries.
Funding
Abstract
aimsAmong adults with insulin- and/or secretagogue-treated diabetes in the United States, very little is known about the real-world descriptive epidemiology of iatrogenic severe (level 3) hypoglycaemia. Addressing this gap, we collected primary, longitudinal data to quantify the absolute frequency of events as well as incidence rates and proportions. MATERIALS AND
methodsiNPHORM is a US-wide, 12-month ambidirectional panel survey (2020-2021). Adults with type 1 diabetes mellitus (T1DM) or insulin- and/or secretagogue-treated type 2 diabetes mellitus (T2DM) were recruited from a probability-based internet panel. Participants completing ≥1 follow-up questionnaire(s) were analysed.
resultsAmong 978 respondents [T1DM 17%; mean age 51 (SD 14.3) years; male: 49.6%], 63% of level 3 events were treated outside the health care system (e.g. by family/friend/colleague), and <5% required hospitalization. Following the 12-month prospective period, one-third of individuals reported ≥1 event(s) [T1DM 44.2% (95% CI 36.8%-51.8%); T2DM 30.8% (95% CI 28.7%-35.1%), p = .0404, α = 0.0007]; and the incidence rate was 5.01 (95% CI 4.15-6.05) events per person-year (EPPY) [T1DM 3.57 (95% CI 2.49-5.11) EPPY; T2DM 5.29 (95% CI 4.26-6.57) EPPY, p = .1352, α = 0.0007]. Level 3 hypoglycaemia requiring non-transport emergency medical services was more common in T2DM than T1DM (p < .0001, α = 0.0016). In total, >90% of events were experienced by <15% of participants.
conclusionsiNPHORM is one of the first long-term, prospective US-based investigations on level 3 hypoglycaemia epidemiology. Our results underscore the importance of participant-reported data to ascertain its burden. Events were alarmingly frequent, irrespective of diabetes type, and concentrated in a small subsample.
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