Interoceptive Awareness Moderates the Relationship Between Hypoglycemia Exposure and Symptom Recognition in Adults with Type 1 Diabetes

<p dir="ltr">Objective: Hypoglycemia exposure lowers the glycemic threshold for symptom recognition, contributing to impaired awareness of hypoglycemia (IAH). Interoceptive awareness, the ability to sense and interpret internal bodily sensations, is associated with lower risk of IAH. We tested the hypothesis that interoceptive awareness moderates the association between hypoglycemia exposure and glycemic threshold for autonomic symptom recognition.</p><p dir="ltr">Research Design and Methods: Adults with type 1 diabetes completed validated surveys assessing interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness, Version 2 [MAIA-2]) and the glycemic threshold for autonomic symptom recognition (Hypoglycemia Awareness Questionnaire [HypoA-Q] ‘Symptom Level’ subscale) and provided 30-day continuous glucose monitoring data. We used proportional odds logistic regression to examine whether the MAIA-2 “Attention Regulation” scale score (measuring the ability to sustain and control attention to bodily sensations) moderated the association between hypoglycemia exposure (%Time <60 mg/dL) and Symptom Level, adjusting for covariates.</p><p dir="ltr">Results: Among 717 participants (94% White, 52% female; mean±SD age: 44±15 years; diabetes duration: 25±15 years; 17% with IAH), 30-day hypoglycemia exposure (%Time <60 mg/dL) was 0.8±1.4% (11.5±20.2 minutes/day). Higher hypoglycemia exposure was associated with lower Symptom Levels (OR: 0.45, 95%CI [0.31, 0.66], P<0.001). Interoceptive awareness alone was not associated with Symptom Level (OR: 0.93, 95%CI [0.78, 1.12]), but higher interoceptive awareness attenuated the association between hypoglycemia exposure and Symptom Level (OR:1.14, 95%CI [1.01, 1.27], P< 0.05).</p><p dir="ltr">Conclusions: Interoceptive awareness moderated the association between hypoglycemia exposure and glycemic threshold for symptom recognition. Research is needed to examine whether interventions can improve interoceptive awareness and, thereby, restore awareness of hypoglycemia. </p>