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 recognize the early symptoms of hypoglycemia, which in turn increases the risk of severe hypoglycemic episodes and related complications. This study aimed to identify factors associated with IAH among patients 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 variables (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 individualized counseling on hypoglycemia prevention and management, are recommended to reduce the risk of IAH and promote safer glycemic control among patients with T2DM.