Impaired awareness of hypoglycemia (IAH) increases the risk of severe hypoglycemia. Questionnaires may allow for easy identification of patients with IAH andfacilitate appropriate intervention. This study aims to assess the clinical utility of commonly used questionnaires fordiagnosing IAH, providing practical insight for medical professionals. Additionally, weseek to identify clinical factors associated with IAH in adults with type 1 diabetes (T1D), enhancing understanding of this condition in a real-world context. The study included 252 adults with T1D (135 men) aged 41 years (IQR: 30-52). Awareness ofhypoglycemia using the validated questionnaires [Clarke scale, Gold scale, and Hypoglycemia Awareness Questionnaire (HypoA-Q)], anthropometric data, and metabolic control were evaluated. To estimate the optimal cut-off point for the diagnosis of IAH using HypoA-Q, the Receiver Operating Characteristic (ROC) curve analysis wasused. IAH was diagnosed by at least one abnormal questionnaire score. We found a cut-off point of 9 points for diagnosing IAH on HypoA-Q (sensitivity of79%, specificity of 82%, AUC = 0.898). IAH in any abnormal test was found in 98 patients (39%). In the univariable logistic regression models, the diagnosis of IAH was associated with lifetime episodes of severe hypoglycemia, hypertension, glycated hemoglobin (A1c) value, mean glycemia, standard deviation (SD), total, LDL and non-HDL cholesterol levels, anddaily dose of insulin. The HypoA-Q, with a 9-point cut-off, demonstrated the highest sensitivity fordiagnosing IAH, and may be considered the most valuable screening tool for IAH detection.
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