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A Comparison of the Rates of Clock-Based Nocturnal Hypoglycemia and Hypoglycemia While Asleep Among People Living with Diabetes: Findings from the Hypo-METRICS Study

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posted on 2024-04-25, 12:48 authored by Gilberte Martine-Edith, Patrick Divilly, Natalie Zaremba, Uffe Søholm, Melanie Broadley, Petra Martina Baumann, Zeinab Mahmoudi, Mikel Gomes, Namam Ali, Evertine J Abbink, Bastiaan de Galan, Julie Brøsen, Ulrik Pedersen-Bjergaard, Allan A Vaag, Rory J McCrimmon, Eric Renard, Simon Heller, Mark Evans, Monika Cigler, Julia K Mader, Jane Speight, Frans Pouwer, Stephanie A Amiel, Pratik Choudhary, for the Hypo-RESOLVE
Introduction Nocturnal hypoglycemia is generally calculated between 00:00 and 06:00. However, those hours may not accurately reflect sleeping patterns and it is unknown whether this leads to bias. We therefore compared hypoglycemia rates whilst asleep to those of clock-based nocturnal hypoglycemia in adults with type 1 (T1D) or insulin-treated type 2 diabetes (T2D). Methods Participants from the Hypo-METRICS study wore a blinded continuous glucose monitor and a Fitbit Charge 4 activity monitor for 10 weeks. They recorded details of episodes of hypoglycemia using a smartphone app. Sensor-detected hypoglycemia (SDH) and person-reported hypoglycemia (PRH) were categorized as nocturnal (00:00-06:00hrs) vs diurnal and whilst asleep vs awake defined by Fitbit sleeping intervals. Paired sample Wilcoxon tests were used to examine the differences in hypoglycemia rates. Results 574 participants (47% T1D, 45% women, 89% White, median (IQR) age 56 (45-66) years and HbA1c 7.3% (6.8-8.0)) were included. Median sleep duration was 6.1h (5.2-6.8), bedtime and waking time approximately 23:30 and 07:30 respectively. There were higher median weekly rates of SDH and PRH whilst asleep than clock-based nocturnal SDH and PRH among people with T1D, especially for SDH<70 mg/dL (1.7 vs 1.4, p<0.001). Higher weekly rates of SDH whilst asleep than nocturnal SDH were found among people with T2D, especially for SDH<70 mg/dL (0.8 vs 0.7, p<0.001). Conclusion Using 00:00 to 06:00 as a proxy for sleeping hours may underestimate hypoglycemia whilst asleep. Future hypoglycemia research should consider the use of sleep trackers to record sleep and reflect hypoglycemia whilst asleep more accurately.


National Institute for Health and Care Research (NIHR) King’s Clinical Research Facility and the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.

Hypo-RESOLVE has received funding from theInnovative Medicines Initiative 2 Joint Undertaking ( JU)under grant agreement No 777460. The JU receives supportfrom the European Union’s Horizon 2020 research and in-novation programme and EFPIA and T1D Exchange, JDRF,International Diabetes Federation (IDF), and The Leona M.and Harry B. Helmsley Charitable Trust. The industry part-ners supporting the JU include Abbott Diabetes Care, EliLilly, Medtronic, Novo Nordisk, and Sanofi-Aventis.


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College of Life Sciences/Population Health Sciences


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Diabetes Technology & Therapeutics


Mary Ann Liebert Inc





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United States



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Professor Pratik Choudhary

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