Severe hypoglycemia poses a major threat to older adults with diabetes, yet population-based evidence is limited. The iNPHORM cohort study, presented at the European Association for the Study of Diabetes (EASD) 2025, assessed the real-world burden and risk factors of Level 3 hypoglycemia among adults aged 60 years and older with type 1 or insulin/secretagogue-treated type 2 diabetes.

The analysis included 310 participants (mean age 67.5 years; 53.9% men; 8.7% with type 1 diabetes) followed for 12 months through monthly surveys. The overall incidence proportion was 20% (95% CI 16.2–25.2), and the annualized event rate reached 1.08 events per person-year. Type 1 diabetes showed higher crude rates, though diabetes type was not an independent predictor after adjustment.

Independent risk factors were female sex, non-White race, greater number of diabetes complications, and extended use of real-time continuous or flash glucose monitoring. The findings suggest that alarm fatigue, fear of hyperglycemia, or insufficient support may contribute to hypoglycemia risk in long-term device users.

These results highlight a substantial and under-recognized burden of severe hypoglycemia in older adults, reinforcing the need for tailored education, risk assessment, and follow-up to prevent serious outcomes in this vulnerable population.