Hypoglycemia unawareness and autonomic dysfunction in diabetes: Lessons learned and roles of diabetes technologies

Yu Kuei Lin, Simon J. Fisher, Rodica Pop-Busui

Research output: Contribution to journalReview articlepeer-review

31 Scopus citations


Impaired awareness of hypoglycemia (IAH) is a reduction in the ability to recognize low blood glucose levels that would otherwise prompt an appropriate corrective therapy. Identified in approximately 25% of patients with type 1 diabetes, IAH has complex pathophysiology, and might lead to serious and potentially lethal consequences in patients with diabetes, particularly in those with more advanced disease and comorbidities. Continuous glucose monitoring systems can provide real-time glucose information and generate timely alerts on rapidly falling or low blood glucose levels. Given their improvements in accuracy, affordability and integration with insulin pump technology, continuous glucose monitoring systems are emerging as critical tools to help prevent serious hypoglycemia and mitigate its consequences in patients with diabetes. This review discusses the current knowledge on IAH and effective diagnostic methods, the relationship between hypoglycemia and cardiovascular autonomic neuropathy, a practical approach to evaluating cardiovascular autonomic neuropathy for clinicians, and recent evidence from clinical trials assessing the effects of the use of CGM technologies in patients with type 1 diabetes with IAH.

Original languageEnglish
Pages (from-to)1388-1402
Number of pages15
JournalJournal of Diabetes Investigation
Issue number6
StatePublished - Nov 1 2020

Bibliographical note

Funding Information:
SJF is supported by the NIH R01DK118082. RPB is supported by NIH 1R01DK107956‐01 and U01DK119083, and the JDRF Center of Excellence at the University of Michigan.

Publisher Copyright:
© 2020 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd


  • Cardiovascular autonomic neuropathy
  • Impaired awareness of hypoglycemia
  • Type 1 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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