Factors associated with impaired hypoglycemia awareness in patients with type 2 diabetes in Korea: a cross-sectional study

Purpose: Impaired awareness of hypoglycemia (IAH) is characterized by a diminished ability to recog-nize the early symptoms of hypoglycemia, which in turn increases the risk of severe hypoglycemic epi-sodes and related complications. This study aimed to identify factors associated with IAH among pa-tients with type 2 diabetes mellitus (T2DM). Methods: A descriptive survey was conducted among 185 outpatients aged ≥ 19 years who had been diagnosed with T2DM and had received oral hypoglycemic agents or insulin therapy for more than 6 months. IAH was assessed using the Clarke Questionnaire. Potential associated factors included sociodemographic characteristics, clinical and treatment vari-ables (e.g., hemoglobin A1c [HbA1c] and blood pressure), health behaviors, body composition metrics, and hypoglycemia-related factors. Data were analyzed using the chi-square test, the Fisher exact test, independent-sample t-tests, and stepwise regression analysis. Results: The prevalence of IAH was 13.5%. Factors significantly associated with IAH were the duration of diabetes (β = −0.38, p = .010) and the use of insulin degludec (β = 0.29, p = .015). Conclusion: These findings suggest that longer disease duration and specific treatment modalities, particularly the use of insulin degludec, are key factors associated with IAH. Accordingly, patients with long-standing T2DM should be prioritized for regular IAH screening. Furthermore, targeted nursing interventions, such as structured hypoglycemia education tailored for insulin degludec users, frequent self-monitoring of blood glucose, and individu-alized counseling on hypoglycemia prevention and management, are recommended to reduce the risk of IAH and promote safer glycemic control among patients with T2DM.