Hypoglycaemia remains a critical concern in people with insulin-treated type 2 diabetes, particularly during the night. The European Association for the Study of Diabetes (EASD) 2025 study investigated whether hypoglycaemia awareness influences progression from level 1 (L1, <3.9 mmol/L) to level 2 (L2, <3 mmol/L) hypoglycaemia during waking and sleeping hours.

Data from 287 participants using blinded continuous glucose monitoring and actigraphy for 10 weeks were analyzed. Participants were classified as having normal awareness of hypoglycaemia (NAH) or impaired awareness of hypoglycaemia (IAH) using the Gold score. Sensor-detected hypoglycaemia events were tracked, and progression from L1 to L2 was calculated for both sleep and wake periods.

Results showed that progression from L1 to L2 was significantly higher during sleep than while awake (19% vs 11%) in both NAH and IAH groups. No significant differences were observed between NAH and IAH participants in either waking or sleeping periods.

These findings suggest that nocturnal progression of hypoglycaemia is primarily influenced by sleep-related physiological factors rather than awareness status, emphasizing the need for strategies targeting nighttime glycaemic control.