Real‐world incidence and risk factors of level 3 (severe) hypoglycaemia in adults with type 1 or 2 diabetes ( iNPHORM , United States)
Authors' conclusion
Level 3 hypoglycaemia remains common in T1D and T2D. Findings support risk-targeted prevention and diabetes care strategies that co-prioritize safety and effectiveness.
Study context
- Population
- US adults (aged 18–90) with T1D or insulin- and/or secretagogue-treated T2DT1D: 16.7%
- Participants
- 985 adults
- Exposure
- T1D vs T2D
- Outcome
- Incidence (crude incidence proportion and annualized event rate) of Level 3 (severe) hypoglycaemia
- Follow-up
- 12 months
Methodological detailsinternet panel survey, 12-month follow-up
- Internet panel survey
- 12-month follow-up
Main finding
As reported in the abstract
over follow-up
| Group | Value | Annualized rate (EPPY) |
|---|---|---|
| T1D | 45.0% | 3.56 |
| T2D | 33.0% | 5.26 |
Value
T1D45.0%
T2D33.0%
Annualized rate (EPPY)
T1D3.56
T2D5.26
- Overall ≥1 Level 3 event
- 35.0%
- Overall annualized rate (EPPY)
- 4.98
Observational data: associations, not effects.
Further findings
Risk factors for Level 3 hypoglycaemia rate in T1D (RR)
RR
- Non-White
- 2.03
- Prior DKA
- 6.49
- Greater fear of hypoglycaemia
- 1.41
- Prior diabetes education (protective)
- 0.42
Risk factors for Level 3 hypoglycaemia rate in T2D (RR)
RR
- Age, per 10-year increase (higher rates with younger age)
- 0.77
- Greater fear of hypoglycaemia
- 1.18
- More diabetes visits
- 1.72
- Greater number of past healthcare-requiring severe hypoglycaemia
- 1.12
- Also higher with more diabetes complications, higher secretagogue dose, longer CGM/flash monitoring use, impaired awareness of hypoglycaemia
Original publication
Real‐world incidence and risk factors of level 3 (severe) hypoglycaemia in adults with type 1 or 2 diabetes ( iNPHORM , United States). Diabetes Obes Metab. Published 3 November 2025. doi:10.
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