Evidence mapPaperPMID 41578685Full record

Observational studyDiabetic medicine : a journal of the British Diabetic Association2026

Associations between impaired awareness of hypoglycaemia and mental health in insulin-treated type 2 and type 1 diabetes in the Hypo-METRICS study.

Aisling McCarthy, Jonah Thomas, Eduardo Avila, Vaios Koutroukas, Beatrice Pieri, Natalie Zaremba, Stephanie A Amiel, François Pouwer, Pratik Choudhary, Patrick Divilly and 1 more

Abstract readObservational Study
In one paragraph

Observational study in Diabetic medicine : a journal of the British Diabetic Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing 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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

11 authors.

Aisling McCarthyUniversity College Dublin, Dublin, Ireland.ORCID https://orcid.org/0009-0001-0550-1635
Jonah ThomasDiabetes Research Centre, University of Leicester, Leicester, UK.ORCID https://orcid.org/0000-0002-9886-0169
Eduardo AvilaDepartment of Computer Sciences, Maynooth University, Maynooth, Ireland.ORCID https://orcid.org/0009-0003-1781-0093
Vaios KoutroukasDiabetes Research Centre, University of Leicester, Leicester, UK.
Beatrice PieriDiabetes Research Centre, University of Leicester, Leicester, UK.
Natalie ZarembaDepartment of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.ORCID https://orcid.org/0000-0002-1720-1621
Stephanie A AmielDepartment of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.ORCID https://orcid.org/0000-0003-2686-5531
François PouwerDepartment of Psychology, University of Southern Denmark, Odense, Denmark.ORCID https://orcid.org/0000-0002-8172-9818
Pratik ChoudharyDiabetes Research Centre, University of Leicester, Leicester, UK.ORCID https://orcid.org/0000-0001-7635-4735
Patrick DivillyUniversity College Dublin, Dublin, Ireland.
Hypo‐RESOLVE Consortium

Funding

Innovative Medicines Initiative 2 Joint Undertaking (JU) 777460
6 · The paper itself

Abstract

aimsThe mental health impact of impaired awareness of hypoglycaemia (IAH) in people with type 2 diabetes (T2D) is not known. We explored this in people with insulin-treated T2D and type 1 diabetes (T1D).

methodsHypo-METRICS was a 10-week cross-sectional observation of hypoglycaemia experience, collecting data on glucose and activity. Participants (325 insulin-treated T2D, 277 T1D) completed questionnaires scoring depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and fear of hypoglycaemia (HFS-II [worry]) at baseline. IAH was defined as a Gold score ≥4. Relationships between IAH and mental health scores were explored using unadjusted and adjusted generalised linear regression analyses. Age, sex, race, diabetes duration, level of education, employment status, continuous glucose monitoring (CGM) use, hypoglycaemia, use of anti-depressants and use of anti-anxiety medications were covariates in the adjusted regression.

resultsIn unadjusted regression in insulin-treated T2D, IAH was associated with higher PHQ-9 (6.4% [1.5%-11.3%]; p = 0.011), GAD-7 (7.6% [2.1%-13%]; p = 0.006) and HFS-II (worry) (7.4% [2.8%-12%]; p = 0.002) scores, with no differences in PAID (p = 0.655). After adjustment, IAH was associated with higher HFS-II (worry) (5.3% [0.3%-10.6%]; p = 0.048) only. In T1D, IAH was associated with higher PHQ-9 (6.2% [1.3%-10.8%]; p = 0.012), GAD-7 (6.1% [0.1%-12.2%]; p = 0.046) and HFS-II (worry) (6.1% [0.06%-11.5%]; p = 0.029) scores, but not PAID (p = 0.654), all unadjusted. These relationships remained after adjustment, which also showed higher PAID (8.43% [2.62%-14.24%]; p = 0.005).

conclusionOur data demonstrated associations between IAH and a greater mental health burden in both insulin-treated T2D and T1D. Addressing these mental health challenges should be an important part of the holistic care of people with IAH and insulin-treated diabetes.

Indexed as

AwarenessDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2HypoglycemiaHypoglycemic AgentsInsulinMental HealthAdultAnxietyBlood GlucoseContinuous Glucose MonitoringCross-Sectional StudiesDepressionFearFemaleHumansBlood GlucoseHypoglycemic AgentsInsulincontinuous blood glucose monitoringhypoglycaemiaimpaired awareness of hypoglycaemiainsulin‐treated type 2 diabetesmental healthtype 1 diabetes

Identifiers

PMID41578685
PMCPMC12900501

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.