An Evaluation of Methods of Assessing Impaired Awareness of Hypoglycemia in Type 1 Diabetes

Subjective recognition of the warningsymptoms of hypoglycemia is fun-damental to allow self-treatment and prevent progression to severe hypo-glycemia (1,2). Recognition of the onset of these premonitory symptoms consti-tutes awareness of hypoglycemia (3). With increasing duration of insulin ther-apy, many people with type 1 diabetes experience a change in their hypoglyce-mia awareness associated with either a re-duction in symptom intensity or a change in symptom profile or both (3–6). Im-paired awareness of hypoglycemia (IAH) is associated with a sixfold greater fre-quency of severe hypoglycemia and is a recognized risk factor for this proble