Predictors of recurrent severe hypoglycemia in adults type 1 diabetes

New insights from the HypoCOMPaSS trial published in Diabetes Care

By Dr Elizabeth Holmes-Truscott


Severe hypoglycaemia is a very low blood glucose level which requires help from another person to recover.  The aim of the UK HypoCOMPaSS trial was to improve awareness of hypoglycaemia and prevent recurrent severe hypoglycaemia among adults with type 1 diabetes. Participants had access to a brief psycho-educational intervention, 6 months intensive clinical support and were randomised to one of two combinations of insulin pump vs multiple daily injections and continuous glucose monitoring or standard finger-prick monitoring. Overall, HypoCOMPaSS demonstrated a 20-fold reduction in severe hypoglycaemia, improved awareness of hypoglycaemia and improved treatment satisfaction. These results were sustained over 2 years. See our prior blogs for more details (1,2). 

During the 2-year follow-up period, some participants (39%) continued to experience severe hypoglycaemia events. Though at a much lower rate: 2 events per year, compared to 16 events per year before the trial. Dr Anneliese Flatt and colleagues (including ACBRD researchers) conducted additional data analyses to identify predictors of ongoing severe hypoglycaemia following the HypoCOMPaSS trial. Simply put, we wanted to understand why some people continued to experience low rates of severe hypoglycaemia, or why did the intervention work for some but not others?

We found that time spent in low glucose range (<3.0 mmol/L) did not differ between groups, and those with recurrent severe hypoglycaemia administered a lower daily insulin dose. However, those who continued to experience low rates of severe hypoglycaemia had a higher rate of severe hypoglycaemia at baseline and greater fear of hypoglycaemia. This group were also more likely to report impaired awareness of hypoglycaemia at follow-up. Finally, neuropathy was more common in this group.

These findings provide further support for early psycho-educational intervention, clinical support, and appropriate insulin reduction to avoid hypoglycaemia among people with type 1 diabetes experiencing recurrent severe hypoglycaemia.

To read more about hypoglycaemia, check out our previous blogs on this topic.

Flatt AJ, Little SA, Speight J, Leelarathna L, Walkinshaw E, Tan HK, Bowes A, Lubina-Solomon A, Holmes-Truscott E, Chadwick TJ, Wood R. Predictors of recurrent severe hypoglycemia in adults with type 1 diabetes and impaired awareness of hypoglycemia during the HypoCOMPaSS study. Diabetes care. 2020 Jan 1;43(1):44-52.