Severe hypoglycemia remains a major acute complication of type 1 diabetes mellitus (T1DM), and identifying individuals at the highest risk is important for improving preventive strategies in routine care. A multicenter case–control analysis published in the Journal of Diabetes & Metabolic Disorders evaluated predictors of severe hypoglycemia among adults with T1DM treated with multiple daily insulin injections (MDI).

The SEvere HYpoglycemia in ANdalusia (SEHYPAN) study included adults who required pre-hospital emergency care for severe hypoglycemia between 2018 and 2022. Each case was matched by sex, age, glucose monitoring method (self-monitoring of blood glucose or intermittently scanned continuous glucose monitoring), and reference health-care area with controls who had not experienced severe events. Logistic regression analyses were used to identify independent predictors, and nomograms were developed to estimate individualized risk.

A total of 1,464 participants were analyzed, including 799 cases and 665 matched controls. Individuals who experienced severe hypoglycemia had longer diabetes duration, more comorbidities, and higher prevalence of smoking and alcohol use compared with controls (all p < 0.001). Two predictive nomogram models were constructed. The overall cohort model incorporated glucose monitoring modality, history of severe and nocturnal hypoglycemia, comorbid depression, alcohol use, and chronic conditions.

A second model, specific to intermittently scanned continuous glucose monitoring users, also included time in range and time below range. In the full cohort model, intermittently scanned continuous glucose monitoring use was independently associated with lower odds of severe hypoglycemia. Both models showed good predictive performance with area under the curve values ranging from 0.75 to 0.83 and a sensitivity of at least 0.75. The nomogram models provide individualized estimates of severe hypoglycemia risk in adults with T1DM receiving MDI therapy.