ArticleDiabetes care2025
Time Below Range and Its Influence on Hypoglycemia Awareness and Severe Hypoglycemia: Insights From the Association of British Clinical Diabetologists Study.
Article in Diabetes care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- 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
- Reduced Prevalence of Impaired Awareness of Hypoglycemia Over Two Decades in Population-Based Samples of Youth With Type 1 Diabetes.Diabetes care · 2026Article
- Identification of Different Age-at-Diagnosis-Based Endotypes and Clinical Phenotypes in a Cohort of Adult Patients Diagnosed with Type 1 Diabetes.Journal of clinical medicine · 2026Article
- Life-threatening acute complications persist among individuals with type 1 diabetes in Japan: A nationwide registry-based cross-sectional study.Journal of diabetes investigation · 2026Article
- Development and Validation of Nomogram-Based Predictive Models for Severe Hypoglycemia in Adults With Type 1 Diabetes Treated With Multiple Daily Injections: The SEHYPAN Study.Diabetes/metabolism research and reviews · 2026Observational
- Time below range alone is insufficient to identify severe hypoglycaemia risk in type 1 diabetes-the critical role of hypoglycaemia awareness: results from the SFDT1 study.Diabetologia · 2025Observational
- 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
- Predictors of impaired awareness of hypoglycaemia and severe hypoglycaemia in adults with type 1 diabetes.Diabetic medicine : a journal of the British Diabetic Association · 2025Article
- Real-world evaluation of automated insulin delivery therapy in type 1 diabetes: A multicentre study across regional and metropolitan Queensland, Australia.Diabetes, obesity & metabolism · 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
- The impact of technology on impaired awareness of hypoglycaemia in type 1 diabetes.Therapeutic advances in endocrinology and metabolism · 2025Review
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveThis study aimed to explore the relationship between time below range (TBR), impaired awareness of hypoglycemia (IAH), and severe hypoglycemia (SH). RESEARCH DESIGN AND
methodsThis cross-sectional study analyzed data from individuals with diabetes using continuous glucose monitors (CGMs) in the Association of British Clinical Diabetologists audit. Hypoglycemia awareness was assessed via the Gold score (≥4 denoting IAH), and SH was defined as hypoglycemia requiring third-party assistance. Logistic regression was used to determine the association between TBR percentage (<70 mg/dL; 3.9 mmol/L) at first follow-up and follow-up Gold score and SH incidence. The Youden J index identified optimal TBR percentage cutoffs for detecting IAH and SH.
resultsThe study included 15,777 participants, with follow-up TBR and SH data available for 5,029. The median TBR percentage was 4% (interquartile range 2-6.6%), with 42% meeting the recommended TBR of ≤4%. Adjusted for age, sex, and BMI, TBR was significantly associated with SH (P < 0.001) and IAH (P = 0.005). Optimal TBR cutoffs for identifying IAH and SH were 3.35% and 3.95%, yielding negative predictive value (NPV) values of 85% and 97%, respectively.
conclusionsOur findings support the international consensus recommending a TBR of <4% in type 1 diabetes, with high NPV values suggesting the utility of TBR in screening for SH.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.