Validating and Establishing a Diagnostic Threshold for the Hypoglycemia Awareness Questionnaire Impaired Awareness Subscale
Authors' conclusion
These findings support the validity of the HypoA-Q IA subscale and propose a HypoA-Q IA diagnostic threshold to identify IAH in both clinical and research settings.
Study context
- Population
- Adults with T1D (male, 48%; median age, 36 years; T1D duration, 21 years); those with impaired awareness of hypoglycemia (IAH) (Clarke score ≥4) and severely problematic hypoglycemia and/or marked glycemic lability started AID10 with IAH
- Participants
- 21 adults
- Outcome
- Discriminant and convergent validity of the HypoA-Q IA subscale and a diagnostic threshold for IAH classification
Methodological detailsvalidation study, within 18-month intervention study, hyperinsulinemic hypoglycemic clamp
- Validation study
- Within 18-month intervention study
- Hyperinsulinemic hypoglycemic clamp
Performance
As reported in the abstract
Prediction of abnormal symptom response to insulin-induced hypoglycemia (ROC analysis)
| Test or model | AUC | Optimal threshold | Sensitivity | Specificity |
|---|---|---|---|---|
| HypoA-Q IA subscale | 0.86 | 12 | 83% | 80% |
HypoA-Q IA subscale
AUC0.86
Optimal threshold12
Sensitivity83%
Specificity80%
- Discriminated between those with and without IAH defined by Clarke score (W = 110.5)
- P < 0.001
Further findings
Convergent validity during intervention: correlations with HypoA-Q IA subscale
- Clarke score
- r = 0.72; P <.001
- HYPO score
- r = 0.60; P <.001
- Hypoglycemia exposure <70 mg/dL
- r = 0.53; P <.01
- Hypoglycemia exposure <60 mg/dL
- r = 0.50; P <.01
- Hypoglycemia exposure <54 mg/dL
- r = 0.48; P <.01
- Autonomic symptom response to insulin-induced hypoglycemia
- r = −0.53; P <.05
- Epinephrine response
- r = −0.68; P <.001
- Pancreatic polypeptide response
- r = −0.52; P <.05
Original publication
Validating and Establishing a Diagnostic Threshold for the Hypoglycemia Awareness Questionnaire Impaired Awareness Subscale. Endocr Pract. Published 21 August 2023. doi:10.
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