Repository logo

The impact of hypoglycaemia on daily functioning among adults with diabetes: a prospective observational study using the Hypo-METRICS Application

Accepted version



Change log


Søholm, Uffe 
Broadley, Melanie 
Zaremba, Natalie 
Divilly, Patrick 


Abstract Aims/hypothesis: To examine the impact of hypoglycaemia on daily functioning among adults with type 1 diabetes or insulin-treated type 2 diabetes, using the novel Hypo-METRICS application. RESEARCH DESIGN AND METHODS For 70 consecutive days, 594 adults (type 1 diabetes: n=274; type 2 diabetes: n=320) completed brief morning and evening Hypo-METRICS ‘check-ins’ about their experienced hypoglycaemia and daily functioning. Participants wore a blinded glucose sensor for the study duration. Days and nights with or without person-reported hypoglycaemia (PRH) and/or sensor-detected hypoglycaemia (SDH) were compared using multilevel regression models.
RESULTS Participants submitted a mean of 86.3±12.5% morning and 90.8±10.7% evening check-ins. For both types of diabetes, SDH alone had no significant associations to the changes in daily functioning scores. However, daytime and night-time PRH (with or without SDH) were significantly associated with worsening of energy levels, mood, cognitive functioning, negative affect and fear of hypoglycaemia later that day/while asleep. In addition, night-time PRH (with or without SDH) was significantly associated with worsening of sleep quality (type 1 and 2 diabetes), and memory (type 2 diabetes). Further, daytime PRH (with or without SDH), was associated with worsening of fear of hyperglycemia while asleep (type 1 diabetes), memory (type 1 and 2 diabetes) and social functioning (type 2 diabetes). CONCLUSIONS This prospective, real-world study reveals impact on several domains of daily functioning following PRH, but not following SDH alone. These data suggest that the observed negative impact is mainly driven by subjective awareness of hypoglycaemia (i.e., PRH), through either symptoms or sensor alerts/readings and/or the need to take action to prevent or treat them.



Journal Title


Conference Name

Journal ISSN


Volume Title



Publisher DOI

Publisher URL

This work was supported by the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 777460. The JU receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA and type 1 diabetes Exchange, JDRF, International Diabetes Federation (IDF) and The Leona M. and Harry B. Helmsley Charitable Trust. The industry partners supporting the JU include Abbott Diabetes Care, Eli Lilly, Medtronic, Novo Nordisk and Sanofi-Aventis. The funder had no role in the design of the project or its WPs, the collection or analysis of data, the writing of the manuscript or the decision to submit for publication. This paper reflects the author's view and the JU is not responsible for any use that may be made of the information it contains. JS and CH are supported by core funding to the Australian Centre for Behavioural Research in Diabetes provided by the collaboration between Diabetes Victoria and Deakin University. GME’s position at King’s College London is funded by a grant from Novo Nordisk. The University of Cambridge has received salary support for MLE through the National Health Service in the East of England through the Clinical Academic Reserve and work supported by the NIHR Cambridge Biomedical Research Centre and carried out in the NIHR Cambridge Clinical Research Facility/ Translational Research Facility. This study represents independent research supported by the National Institute for Health and Care Research (NIHR) King’s Clinical Research Facility and the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.