Comparing the Validity of Three Methods for Identifying Impaired Awareness of Hypoglycemia in Predicting Severe Hypoglycemia in Adults with Type 1 Diabetes Mellitus: The PR-IAH Study

Objective Impaired awareness of hypoglycemia (IAH) contributes to severe hypoglycemia (SH) in adults with type 1 diabetes mellitus (T1DM). This study compared the validity of the Gold, Clarke, and Pedersen-Bjergaard methods for predicting SH in Japanese adults with T1DM. Methods IAH was assessed at baseline using three methods, and a prospective cohort study was conducted in adults with T1DM. Multivariate Cox proportional hazards regression models adjusted for covariates were used to compare the three methods for predicting SH, and diagnostic validity was calculated. Patients We enrolled 286 participants (mean age: 50.5±14.6 years, men: 36.7%, diabetes duration: 17.6±11.1 years, mean HbA1c level: 7.7±0.9%). Results The prevalence of IAH identified using the Gold, Clarke, and Pedersen-Bjergaard methods was 12.2%, 19.2%, and 30.1%, respectively. The Clarke method showed the strongest association with SH [adjusted hazard ratio (aHR), 8.27; 95% confidence interval (CI), 3.43-20.0, p<0.001], whereas the Gold and Pedersen-Bjergaard methods had associations of aHR 1.90 (95% CI: 0.67-5.36, p=0.227) and aHR 2.65 (95% CI: 1.16-6.03; p=0.020), respectively. The Clarke method demonstrated 65.2% sensitivity, 84.8% specificity, a 27.3% positive predictive value, a 96.5% negative predictive value, a positive likelihood ratio of 4.29, a negative likelihood ratio of 0.41, and an overall diagnostic validity of 83.2%. Conclusion Among the three methods, the Clarke method demonstrated the highest validity for predicting SH development. This information may assist physicians in assessing IAH in clinical practice.