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Acta Diabetol. 2015 Oct;52(5):845-53. doi: 10.1007/s00592-015-0713-4. Epub 2015 Feb 12.

Incidence and risk factors for severe and symptomatic hypoglycemia in type 1 diabetes. Results of the HYPOS-1 study.

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Metabolism and Diabetes Unit, ASL TO5, Via De Maria, 1, 10023, Chieri, TO, Italy.
Departmental Service of Diabetology and Metabolic Diseases, ASL TO3, Pinerolo, TO, Italy.
Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
Metabolism and Diabetes Unit Hospital St. Martin, Genoa, Italy.
Metabolism and Diabetes Unit, ASL TO4, Chivasso, Italy.
Metabolism and Diabetes Unit, ASL 1, Massa Carrara, Italy.
Metabolism and Diabetes Unit, ASL di Bari, Rutigliano, Italy.
Laboratory of Clinical Epidemiology of Diabetes and Chronic Diseases, Fondazione Mario Negri Sud, Santa Maria Imbaro, CH, Italy.



Hypoglycemia is common in type 1 diabetes mellitus (T1DM). We aimed to update the incidence of severe and symptomatic hypoglycemia and investigate several correlated factors.


In this multicenter, observational retrospective study, the data of 206 T1DM patients from a sample of 2,229 consecutive patients seen at 18 diabetes clinics were analyzed. Sociodemographic and clinical characteristics, severe hypoglycemia in the past 12 months, and symptomatic hypoglycemia in the past 4 weeks were recorded with a self-report questionnaire and a clinical form during a routine visit. Poisson multivariate models were applied.


A minority of patients accounted for the majority of both severe and symptomatic episodes. The incidence rate (IR) of severe hypoglycemia was 0.49 (0.40-0.60) events/person-years. The incidence rate ratio (IRR) was higher in patients with previous severe hypoglycemia (3.71; 2.28-6.04), neuropathy (4.16; 2.14-8.05), long duration (>20 years, 2.96; 1.60-5.45), and on polypharmacy (1.24; 1.13-1.36), but it was lower when a complication was present. The IR of symptomatic hypoglycemia was 53.3 events/person-years, with an IRR significantly higher among women or patients with better education, or shorter duration or on pumps. The IRR was lower in patients with higher BMI or neuropathy or aged more than 50 years.


Fewer than 20 % of T1DM patients are free from hypoglycemia, with one in six having experienced at least one severe episode in the last year. The distribution is uneven, with a tendency of episodes to cluster in some patients. Severe and symptomatic episodes have different correlates and reflect different conditions.


Hypoglycemia; Incidence; Risks factors; Type 1 diabetes

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