TOPLINE

Prospectively measured hypoglycaemia — sensor-detected or person-reported hypoglycaemia — over 10 weeks showed no association with depression, anxiety, diabetes distress, or fear of the condition in adults with type 1 diabetes (T1D) or insulin-treated type 2 diabetes (T2D).

METHODOLOGY

• This post hoc analysis of the Hypo-METRICS study examined whether exposure to hypoglycaemia was linked to depression, anxiety, diabetes distress, or fear of the condition in adults with diabetes.
• The study included 232 adults with T1D (median age, 49 years; 53% women) and 310 adults with insulin-treated T2D (median age, 63 years; 37.4% women). All participants wore a blinded continuous glucose monitor for 10 weeks and continued their usual glucose monitoring routine, and ecological momentary assessments captured feelings in real time via a mobile app.
• Hypoglycaemia was defined using the time below range at thresholds of < 3.9 and < 3.0 mmol/L, sensor-detected hypoglycaemia at the same two thresholds, and person-reported hypoglycaemia.
• Sensor-detected hypoglycaemia was defined as sensor glucose levels falling below the threshold for more than 15 minutes, and person-reported hypoglycaemia included symptomatic episodes, technology-detected episodes, and total episodes that combined both types.
• Participants completed questionnaires at the beginning and week 10: the nine-item Patient Health Questionnaire for depression, the seven-item Generalized Anxiety Disorder scale for anxiety, the Problem Areas in Diabetes questionnaire for diabetes distress, and the Hypoglycemia Fear Survey-II (worry) for fear of hypoglycaemia.

TAKEAWAY

• In the adjusted analysis, none of the hypoglycaemia metrics — the time below range, sensor-detected hypoglycaemia, or person-reported hypoglycaemia — were significantly associated with anxiety, depression, diabetes distress, or fear of hypoglycaemia after 10 weeks in either diabetes group.

IN PRACTICE

"[The study] data suggest that it may not be the biological low glucose readings that drive the mental health burden. The psychological impact of hypoglycaemia may depend more on experience rather than frequency. Symptomatic hypoglycaemia, particularly when distressing, may have a greater impact on mental health than asymptomatic or technology-detected events," the authors wrote.

SOURCE

The study was led by Aisling McCarthy, University College Dublin, Dublin, Ireland. It was published online on June 30, 2026, as a research letter in Diabetes, Obesity and Metabolism.

LIMITATIONS

One of the main limitations of the study was that it was a post hoc exploratory analysis. The relatively short study duration may have limited the ability to detect changes or longer-term effects on mental health. In addition, mental health scores were collected only at baseline and at the end of the study.

DISCLOSURES

This study was supported by Innovative Medicines Initiative 2 Joint Undertaking. Several authors reported receiving consulting or personal fees, speaker honoraria, research funding or institutional payments, and travel support; serving on advisory boards; and having other ties with multiple companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.