Associations between impaired awareness of hypoglycaemia and mental health in insulin-treated type 2 and type 1 diabetes in the Hypo-METRICS study.

In unadjusted regression, IAH in insulin-treated T2D was associated with higher depression, anxiety, and fear of hypoglycaemia scores but not diabetes distress.

• IAH was associated with higher PHQ-9 scores (6.4% [1.5%–11.3%]; p = 0.011)
• IAH was associated with higher GAD-7 scores (7.6% [2.1%–13%]; p = 0.006)
• IAH was associated with higher HFS-II (worry) scores (7.4% [2.8%–12%]; p = 0.002)
• No significant association was found with PAID diabetes distress scores (p = 0.655)
• Sample consisted of 325 insulin-treated T2D participants

After adjustment for covariates, IAH in insulin-treated T2D was associated only with higher fear of hypoglycaemia scores.

• Only the association with HFS-II (worry) remained significant after adjustment (5.3% [0.3%–10.6%]; p = 0.048)
• Associations with PHQ-9 and GAD-7 did not remain significant after adjustment
• Covariates in the adjusted regression included age, sex, race, diabetes duration, level of education, employment status, CGM use, hypoglycaemia, use of anti-depressants, and use of anti-anxiety medications

In unadjusted regression, IAH in T1D was associated with higher depression, anxiety, and fear of hypoglycaemia scores but not diabetes distress.

• IAH was associated with higher PHQ-9 scores (6.2% [1.3%–10.8%]; p = 0.012)
• IAH was associated with higher GAD-7 scores (6.1% [0.1%–12.2%]; p = 0.046)
• IAH was associated with higher HFS-II (worry) scores (6.1% [0.06%–11.5%]; p = 0.029)
• No significant association was found with PAID diabetes distress scores (p = 0.654)
• Sample consisted of 277 T1D participants

After adjustment for covariates, IAH in T1D remained associated with higher depression, anxiety, fear of hypoglycaemia, and diabetes distress scores.

• Associations with PHQ-9, GAD-7, and HFS-II (worry) remained significant after adjustment
• After adjustment, IAH was also associated with higher PAID scores (8.43% [2.62%–14.24%]; p = 0.005)
• This pattern of associations after adjustment differed from insulin-treated T2D, where only fear of hypoglycaemia remained significant

The Hypo-METRICS study was a 10-week cross-sectional observational study collecting data on hypoglycaemia experience, glucose, and activity.

• Total participants included 325 insulin-treated T2D and 277 T1D individuals
• Mental health questionnaires completed at baseline included PHQ-9 (depression), GAD-7 (anxiety), PAID (diabetes distress), and HFS-II worry subscale (fear of hypoglycaemia)
• IAH was defined as a Gold score ≥4
• Both unadjusted and adjusted generalised linear regression analyses were used to explore relationships between IAH and mental health scores

IAH was associated with greater mental health burden in both insulin-treated T2D and T1D, suggesting mental health challenges should be addressed as part of holistic care.

• The association between IAH and fear of hypoglycaemia was consistent across both diabetes types after adjustment
• In T1D, a broader range of mental health outcomes remained associated with IAH after adjustment compared to T2D
• The authors note that the mental health impact of IAH in people with T2D was not previously known