Evidence map›Paper›PMID 41178794›Full record

ArticleDiabetes, obesity & metabolism2026

Real-world incidence and risk factors of level 3 (severe) hypoglycaemia in adults with type 1 or 2 diabetes (iNPHORM, United States).

Alexandria Ratzki-Leewing, Jason E Black, Jasminder Bhatti, Bridget L Ryan, Guangyong Zou, Yu Kuei Lin, Shuo J Huang, Rozalina G McCoy, Stewart B Harris

Abstract read
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In one paragraph

Article in Diabetes, obesity & metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Alexandria Ratzki-LeewingUniversity of Maryland Institute for Health Computing, North Bethesda, Maryland, USA.ORCID 0000-0002-9474-7900
Jason E BlackDepartment of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, Ontario, Canada.
Jasminder BhattiDepartment of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, Ontario, Canada.
Bridget L RyanDepartment of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, Ontario, Canada.
Guangyong ZouDepartment of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, Ontario, Canada.
Yu Kuei LinDepartment of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.ORCID 0000-0003-1988-7046
Shuo J HuangUniversity of Maryland Institute for Health Computing, North Bethesda, Maryland, USA.
Rozalina G McCoyUniversity of Maryland Institute for Health Computing, North Bethesda, Maryland, USA.
Stewart B HarrisDepartment of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, Ontario, Canada.

Funding

Minimizing Hypoglycemia in Adults with Type 1 Diabetes through an Integrated Mobile Health and Continuous Glucose Monitoring SystemK23DK129724 · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2025 to 2025
$197k
Montgomery County, Maryland and The University of Maryland Strategic Partnership: MPowering the StateNIDDK NIH HHS K23 DK129724NIDDK NIH HHS K23DK129724Sanofi Global
6 · The paper itself

Abstract

aimsLevel 3 (severe) hypoglycaemia is a serious, yet preventable, complication of insulin- or secretagogue-treated diabetes. However, real-world insight into its incidence and risk factors remains limited. We analysed data from the iNPHORM study to address this gap. MATERIALS AND

methodsiNPHORM is a prospective internet panel survey of US adults (aged 18-90) with type 1 diabetes (T1D) or insulin- and/or secretagogue-treated type 2 diabetes (T2D). A screener, baseline and 12-monthly follow-up questionnaires captured data on Level 3 hypoglycaemia and participant characteristics. Crude incidence proportions and annualized event rates were calculated. Repeated LASSO selection and negative binomial regression identified risk factors, with separate models for T1D and T2D.

resultsAmong 985 participants (T1D: 16.7%), 35.0% experienced ≥1 Level 3 event over follow-up (T1D: 45.0%; T2D: 33.0%). The annualized rate was 4.98 EPPY (T1D: 3.56; T2D: 5.26). In T1D, rates were higher among individuals identifying as non-White (RR [rate ratio]: 2.03), with prior diabetes ketoacidosis (RR: 6.49), and greater fear of hypoglycaemia (RR: 1.41). Prior diabetes education (RR: 0.42) was protective. In T2D, rates were higher with younger age (RR: 0.77 per 10-year increase), greater fear of hypoglycaemia (RR: 1.18), more diabetes complications, higher secretagogue dose, more diabetes visits (RR: 1.72), longer use of continuous/flash glucose monitoring, impaired awareness of hypoglycaemia and a greater number of past healthcare-requiring severe hypoglycaemia (RR: 1.12).

conclusionsLevel 3 hypoglycaemia remains common in T1D and T2D. Findings support risk-targeted prevention and diabetes care strategies that co-prioritize safety and effectiveness.

Indexed as

Diabetes Mellitus, Type 1Diabetes Mellitus, Type 2HypoglycemiaHypoglycemic AgentsAdolescentAdultAgedAged, 80 and overFemaleHumansIncidenceInsulinMaleMiddle AgedProspective StudiesRisk FactorsHypoglycemic AgentsInsulinhypoglycaemiainsulininsulin secretagoguespharmacoepidemiologytype 1 diabetes mellitustype 2 diabetes mellitus

Identifiers

PMID41178794
PMCPMC12673432

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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.