Risk factors for hypoglycaemia in adults with type 1 diabetes: a systematic review and meta-analysis.

BACKGROUND

Adult T1DM has a large population base, is insulin dependent, and has a high hazard of hypoglycaemia risk. Therefore, the objective of this systematic review is to evaluate the risk factors linked to the occurrence of hypoglycemia in adult patients with type 1 diabetes mellitus. This analysis aims to aid in the formulation of preventive strategies and support early-stage intervention measures.

METHODS

A computerised search of nine electronic databases, all with a timeframe of construction to December 2024, was conducted to find cross-sectional, cohort, and case-control studies on hypoglycaemia in patients with type 1 diabetes mellitus. The quality of the included studies was evaluated using the American Agency for Healthcare Research and Quality (AHRQ) or the Newcastle-Ottawa Scale (NOS). The combined odds ratio (OR) and the corresponding 95% confidence interval (CI) were calculated to evaluate the effect of the included risk factors on hypoglycaemia.

RESULTS

A total of 31 studies including 54,634 participants were included. A total of 35 potentially relevant risk factors were identified. Ultimately, 18 risk factors were assessed for inclusion in the Meta-analysis, and 9 risk factors were statistically significant (P < 0.05), including disease duration (OR = 1.07, 95% CI: 1.01-1.13), history of hypoglycaemia (OR = 2.31, 95% CI: 1.70-3.15),smoking (OR = 1.17, 95% CI: 1.07-1.28), diabetic nephropathy (OR = 0.83, 95% CI: 0.71-0.98), multiple daily insulin injections (OR = 1.96, 95% CI: 1.46-2.61 ), insulin dose (OR = 1.14, 95% CI: 1.08-1.21), hypoglycaemic unawareness (OR = 5.18, 95% CI: 1.81-14.84), impaired hypoglycaemic awareness (OR = 5.99, 95% CI: 4.62-7.75), diabetic neuropathy (OR = 2.05, 95% CI: 1.12-3.76).

CONCLUSION

This study identified 9 major risk factors affecting hypoglycaemia in adults with type 1 diabetes mellitus, including disease duration, history of hypoglycaemia, smoking, diabetic nephropathy (protective factor), multiple daily insulin injections, insulin dose, hypoglycaemic unawareness, impaired hypoglycaemic awareness and diabetic neuropathy.

CLINICAL TRIAL NUMBER: Not applicable.