{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:37:04Z","timestamp":1787319424776,"version":"build-2736575974"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Innovative Medicines Initiative 2 Joint Undertaking","award":["777460"],"award-info":[{"award-number":["777460"]}]},{"DOI":"10.13039\/501100001631","name":"University College Dublin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001631","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims\/hypothesis<\/jats:title>\n                    <jats:p>The aim of this study was to explore associations between gender and hypoglycaemia experience among people with type 1 diabetes or insulin-treated type 2 diabetes in a free-living environment in the Hypo-METRICS study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The Hypo-METRICS study was a 10-week prospective, cross-sectional observational study of the hypoglycaemia experience. Participants (274 with type 1 diabetes and 321 with type 2 diabetes) wore blinded continuous glucose monitor (CGM) devices and recorded their hypoglycaemia symptoms in real time using a bespoke Hypo-METRICS app. Symptomatic hypoglycaemia was defined as a glucose level &lt;4 mmol\/l or any episode of hypoglycaemic symptoms that was resolved by carbohydrate ingestion. Hypoglycaemia symptoms were defined as autonomic (hunger, sweating, shaking, palpitations) or neuroglycopenic (confusion, difficulty speaking, coordination difficulties, headache). Differences between genders were assessed using \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      , Fisher\u2019s exact and Wilcoxon rank-sum tests and combination analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the type 1 diabetes cohort, 54% were women and 76% of the entire cohort used CGM routinely. In the type 2 diabetes cohort, 63% were men and 41% of the entire cohort used CGM routinely. There were no significant differences in time in hypoglycaemia between genders in either cohort (all\n                      <jats:italic>p<\/jats:italic>\n                      &gt;0.05), but women reported more episodes of symptomatic hypoglycaemia per week (4.3 vs 3.3 episodes\/week in the type 1 diabetes cohort [p=0.003]; 1.4 vs 1.0 episodes\/week in the type 2 diabetes cohort [\n                      <jats:italic>p<\/jats:italic>\n                      =0.006]). In the type 1 diabetes cohort, women reported a broader range of symptom combinations, spanning autonomic and neuroglycopenic symptoms. Confusion was the only reported symptom of hypoglycaemia in 0.9% of episodes in women and 2.3% of episodes in men. In the type 2 diabetes cohort, there were more symptom combinations, and both genders reported a combination of autonomic and neuroglycopenic symptoms. Confusion alone accounted for 0.3% of symptomatic episodes in men in the type 2 diabetes cohort; confusion alone was not observed in women.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>Despite similar exposures to hypoglycaemia, there were differences in hypoglycaemia symptoms between genders in this free-living environment. Further work is needed to elucidate the potential underlying causes of these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06775-6","type":"journal-article","created":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T12:59:14Z","timestamp":1781960354000},"page":"2445-2457","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Gender differences in hypoglycaemia in type 1 and insulin-treated type 2 diabetes: the Hypo-METRICS study"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0550-1635","authenticated-orcid":false,"given":"Aisling","family":"McCarthy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5841-0809","authenticated-orcid":false,"given":"Gr\u00e1inne","family":"Kent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9886-0169","authenticated-orcid":false,"given":"Jonah","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4592-3680","authenticated-orcid":false,"given":"Gilberte","family":"Martine-Edith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1720-1621","authenticated-orcid":false,"given":"Natalie","family":"Zaremba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1781-0093","authenticated-orcid":false,"given":"Eduardo","family":"Avila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2686-5531","authenticated-orcid":false,"given":"Stephanie A.","family":"Amiel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8172-9818","authenticated-orcid":false,"given":"Fran\u00e7ois","family":"Pouwer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7854-4233","authenticated-orcid":false,"given":"Julia K.","family":"Mader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6916-3164","authenticated-orcid":false,"given":"Patrick","family":"Divilly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7635-4735","authenticated-orcid":false,"given":"Pratik","family":"Choudhary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Hypo-RESOLVE Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. L.","family":"Evans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Chapman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Kennet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. E.","family":"de Galan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Heller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Caunt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Hudson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Husband","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Arshad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. J.","family":"McCrimmon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Barnett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Lindsay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Pedersen-Bjergaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Renard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Farret","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. M.","family":"Marteil-Oudrer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Shbat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Crespy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Constanza Thibout","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Pernet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Aldridge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Henderson-Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. A.","family":"Vaag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Banck-Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Carstensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Rasing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Walburgh Schimidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Loewenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Huijsmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. J.","family":"Abbink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Drijver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z.","family":"Mahmoudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Cigler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Br\u00f8sen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,20]]},"reference":[{"issue":"2","key":"6775_CR1","doi-asserted-by":"publisher","first-page":"140","DOI":"10.5455\/msm.2013.25.140-142","volume":"25","author":"M Siddiqui","year":"2013","unstructured":"Siddiqui M, Khan M, Carline T (2013) Gender differences in living with diabetes mellitus. Materia Socio Medica 25(2):140. https:\/\/doi.org\/10.5455\/msm.2013.25.140-142","journal-title":"Materia Socio Medica"},{"issue":"2","key":"6775_CR2","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.diabet.2014.10.007","volume":"41","author":"B Cariou","year":"2015","unstructured":"Cariou B, Fontaine P, Eschwege E et al (2015) Frequency and predictors of confirmed hypoglycaemia in type 1 and insulin-treated type 2 diabetes mellitus patients in a real-life setting: results from the DIALOG study. Diabetes Metab 41(2):116\u2013125. https:\/\/doi.org\/10.1016\/j.diabet.2014.10.007","journal-title":"Diabetes Metab"},{"key":"6775_CR3","doi-asserted-by":"publisher","first-page":"110822","DOI":"10.1016\/j.diabres.2023.110822","volume":"202","author":"MK Talbo","year":"2023","unstructured":"Talbo MK, Lebbar M, Wu Z et al (2023) Gender differences in reported frequency and consequences of hypoglycemia among adults living with type 1 diabetes: results from the BETTER registry. Diabetes Res Clin Pract 202:110822. https:\/\/doi.org\/10.1016\/j.diabres.2023.110822","journal-title":"Diabetes Res Clin Pract"},{"issue":"10","key":"6775_CR4","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1016\/j.jdiacomp.2018.08.009","volume":"32","author":"VN Shah","year":"2018","unstructured":"Shah VN, Wu M, Polsky S et al (2018) Gender differences in diabetes self-care in adults with type 1 diabetes: findings from the T1D Exchange clinic registry. J Diabetes Complications 32(10):961\u2013965. https:\/\/doi.org\/10.1016\/j.jdiacomp.2018.08.009","journal-title":"J Diabetes Complications"},{"issue":"Suppl 1","key":"6775_CR5","first-page":"S1","volume":"42","author":"Diabetes Canada Clinical Practice Guidelines Expert Committee","year":"2018","unstructured":"Diabetes Canada Clinical Practice Guidelines Expert Committee (2018) Clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 42(Suppl 1):S1\u2013S325","journal-title":"Can J Diabetes"},{"key":"6775_CR6","doi-asserted-by":"publisher","first-page":"259","DOI":"10.2147\/DMSO.S313837","volume":"16","author":"H Demirbilek","year":"2023","unstructured":"Demirbilek H, Vuralli D, Haris B, Hussain K (2023) Managing severe hypoglycaemia in patients with diabetes: current challenges and emerging therapies. Diabetes Metab Syndr Obes 16:259\u2013273. https:\/\/doi.org\/10.2147\/DMSO.S313837","journal-title":"Diabetes Metab Syndr Obes"},{"issue":"11","key":"6775_CR7","doi-asserted-by":"publisher","first-page":"108232","DOI":"10.1016\/j.jdiacomp.2022.108232","volume":"37","author":"H Chatwin","year":"2023","unstructured":"Chatwin H, Broadley M, Hendrieckx C et al (2023) The impact of hypoglycaemia on quality of life among adults with type 1 diabetes: results from \u201cYourSAY: Hypoglycaemia.\u201d J Diabetes Complications 37(11):108232. https:\/\/doi.org\/10.1016\/j.jdiacomp.2022.108232","journal-title":"J Diabetes Complications"},{"issue":"1","key":"6775_CR8","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s00125-016-4146-6","volume":"60","author":"The International Hypoglycaemia Study Group","year":"2017","unstructured":"The International Hypoglycaemia Study Group (2017) Glucose concentrations of less than 3.0 mmol\/l (54 mg\/dl) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 60(1):3\u20136. https:\/\/doi.org\/10.1007\/s00125-016-4146-6","journal-title":"Diabetologia"},{"issue":"1","key":"6775_CR9","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/S2213-8587(22)00319-9","volume":"1","author":"T Battelino","year":"2023","unstructured":"Battelino T, Alexander CM, Amiel SA, Arreaza-Rubin G, Beck RW, Bergenstal RM (2023) Continuous glucose monitoring and metrics for clinical trials: an international consensus statement. Lancet Diabetes Endocrinol 1(1):42\u201357. https:\/\/doi.org\/10.1016\/S2213-8587(22)00319-9","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"10","key":"6775_CR10","doi-asserted-by":"publisher","first-page":"1769","DOI":"10.2337\/dc23-2332","volume":"47","author":"P Divilly","year":"2024","unstructured":"Divilly P, Martine-Edith G, Zaremba N et al (2024) Relationship between sensor-detected hypoglycemia and patient-reported hypoglycemia in people with type 1 and insulin-treated type 2 diabetes: the Hypo-METRICS study. Diabetes Care 47(10):1769\u20131777. https:\/\/doi.org\/10.2337\/dc23-2332","journal-title":"Diabetes Care"},{"issue":"8","key":"6775_CR11","doi-asserted-by":"publisher","first-page":"e3332","DOI":"10.1002\/dmrr.3332","volume":"36","author":"M Ibrahim","year":"2020","unstructured":"Ibrahim M, Baker J, Cahn A et al (2020) Hypoglycaemia and its management in primary care setting. Diabetes Metab Res Rev 36(8):e3332. https:\/\/doi.org\/10.1002\/dmrr.3332","journal-title":"Diabetes Metab Res Rev"},{"issue":"2","key":"6775_CR12","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1089\/dia.2021.0216","volume":"24","author":"C HornborgSvensson","year":"2022","unstructured":"Hornborg Svensson C, Henriksen MM, Thorsteinsson B, Pedersen-Bjergaard U (2022) Continuous glucose monitoring (CGM) readings during patient-reported symptomatic hypoglycemia: assessment of the Advanced Technologies and Treatments for Diabetes consensus definition of CGM-recorded hypoglycemia. Diabetes Technol Ther 24(2):130\u2013135. https:\/\/doi.org\/10.1089\/dia.2021.0216","journal-title":"Diabetes Technol Ther"},{"issue":"6","key":"6775_CR13","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1111\/dom.15005","volume":"25","author":"CR Andreasen","year":"2023","unstructured":"Andreasen CR, Andersen A, Hagelqvist PG et al (2023) Sustained heart rate-corrected QT prolongation during recovery from hypoglycaemia in people with type 1 diabetes, independently of recovery to hyperglycaemia or euglycaemia. Diabetes Obes Metab 25(6):1566\u20131575. https:\/\/doi.org\/10.1111\/dom.15005","journal-title":"Diabetes Obes Metab"},{"issue":"12","key":"6775_CR14","doi-asserted-by":"publisher","first-page":"2716","DOI":"10.2337\/db22-0246","volume":"71","author":"CEM Verhulst","year":"2022","unstructured":"Verhulst CEM, Van Heck JIP, Fabricius TW et al (2022) Sustained proinflammatory effects of hypoglycemia in people with type 2 diabetes and in people without diabetes. Diabetes 71(12):2716\u20132727. https:\/\/doi.org\/10.2337\/db22-0246","journal-title":"Diabetes"},{"issue":"6","key":"6775_CR15","doi-asserted-by":"publisher","first-page":"1469","DOI":"10.2337\/diabetes.52.6.1469","volume":"52","author":"RTCE Robinson","year":"2003","unstructured":"Robinson RTCE, Harris ND, Ireland RH, Lee S, Newman C, Heller SR (2003) Mechanisms of abnormal cardiac repolarization during insulin-induced hypoglycemia. Diabetes 52(6):1469\u20131474. https:\/\/doi.org\/10.2337\/diabetes.52.6.1469","journal-title":"Diabetes"},{"issue":"10","key":"6775_CR16","doi-asserted-by":"publisher","first-page":"2160","DOI":"10.1007\/s00125-024-06233-1","volume":"67","author":"U S\u00f8holm","year":"2024","unstructured":"S\u00f8holm U, Broadley M, Zaremba N et al (2024) The impact of hypoglycaemia on daily functioning among adults with diabetes: a prospective observational study using the Hypo-METRICS app. Diabetologia 67(10):2160\u20132174. https:\/\/doi.org\/10.1007\/s00125-024-06233-1","journal-title":"Diabetologia"},{"key":"6775_CR17","volume-title":"Hypoglycemia","author":"PT Mathew","year":"2022","unstructured":"Mathew PT, Thoppil D (2022) Hypoglycemia. StatPearls Publishing, Treasure Island, FL, USA"},{"key":"6775_CR18","doi-asserted-by":"publisher","unstructured":"Cryer PE (2007) Hypoglycemia, functional brain failure, and brain death. J Clin Invest 117(4):868\u2013870. https:\/\/doi.org\/10.1172\/JCI31669","DOI":"10.1172\/JCI31669"},{"issue":"3","key":"6775_CR19","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1210\/jc.2008-1410","volume":"94","author":"PE Cryer","year":"2009","unstructured":"Cryer PE, Axelrod L, Grossman AB et al (2009) Evaluation and management of adult hypoglycemic disorders: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 94(3):709\u2013728. https:\/\/doi.org\/10.1210\/jc.2008-1410","journal-title":"J Clin Endocrinol Metab"},{"issue":"12","key":"6775_CR20","doi-asserted-by":"publisher","first-page":"1568","DOI":"10.1016\/0026-0495(93)90152-E","volume":"42","author":"MP Diamond","year":"1993","unstructured":"Diamond MP, Jones T, Caprio S et al (1993) Gender influences counterregulatory hormone responses to hypoglycemia. Metabolism 42(12):1568\u20131572. https:\/\/doi.org\/10.1016\/0026-0495(93)90152-E","journal-title":"Metabolism"},{"issue":"5","key":"6775_CR21","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1007\/BF00402284","volume":"36","author":"SA Amiel","year":"1993","unstructured":"Amiel SA, Maran A, Powrie JK, Umpleby AM, Macdonald IA (1993) Gender differences in counterregulation to hypoglycaemia. Diabetologia 36(5):460\u2013464. https:\/\/doi.org\/10.1007\/BF00402284","journal-title":"Diabetologia"},{"issue":"1","key":"6775_CR22","doi-asserted-by":"publisher","first-page":"65","DOI":"10.2337\/diabetes.49.1.65","volume":"49","author":"SN Davis","year":"2000","unstructured":"Davis SN, Fowler S, Costa F (2000) Hypoglycemic counterregulatory responses differ between men and women with type 1 diabetes. Diabetes 49(1):65\u201372. https:\/\/doi.org\/10.2337\/diabetes.49.1.65","journal-title":"Diabetes"},{"issue":"3","key":"6775_CR23","doi-asserted-by":"publisher","first-page":"115","DOI":"10.2337\/diaclin.24.3.115","volume":"24","author":"VJ Briscoe","year":"2006","unstructured":"Briscoe VJ, Davis SN (2006) Hypoglycemia in type 1 and type 2 diabetes: physiology, pathophysiology, and management. Clin Diabetes 24(3):115\u2013121. https:\/\/doi.org\/10.2337\/diaclin.24.3.115","journal-title":"Clin Diabetes"},{"issue":"5","key":"6775_CR24","doi-asserted-by":"publisher","first-page":"E1054","DOI":"10.1152\/ajpendo.2000.279.5.E1054","volume":"279","author":"SN Davis","year":"2000","unstructured":"Davis SN, Shavers C, Costa F (2000) Differential gender responses to hypoglycemia are due to alterations in CNS drive and not glycemic thresholds. Am J Physiol Endocrinol Metab 279(5):E1054\u2013E1063. https:\/\/doi.org\/10.1152\/ajpendo.2000.279.5.E1054","journal-title":"Am J Physiol Endocrinol Metab"},{"issue":"7","key":"6775_CR25","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.2337\/diabetes.52.7.1749","volume":"52","author":"DA Sandoval","year":"2003","unstructured":"Sandoval DA, Ertl AC, Richardson MA, Tate DB, Davis SN (2003) Estrogen blunts neuroendocrine and metabolic responses to hypoglycemia. Diabetes 52(7):1749\u20131755. https:\/\/doi.org\/10.2337\/diabetes.52.7.1749","journal-title":"Diabetes"},{"issue":"9","key":"6775_CR26","doi-asserted-by":"publisher","first-page":"e14892","DOI":"10.1111\/dme.14892","volume":"39","author":"P Divilly","year":"2022","unstructured":"Divilly P, Zaremba N, Mahmoudi Z et al (2022) Hypo-METRICS: Hypoglycaemia \u2013 MEasurement, ThResholds and ImpaCtS \u2013 a multi-country clinical study to define the optimal threshold and duration of sensor-detected hypoglycaemia that impact the experience of hypoglycaemia, quality of life and health economic outcomes: the study protocol. Diabet Med 39(9):e14892. https:\/\/doi.org\/10.1111\/dme.14892","journal-title":"Diabet Med"},{"issue":"2","key":"6775_CR27","doi-asserted-by":"publisher","first-page":"e051651","DOI":"10.1136\/bmjopen-2021-051651","volume":"12","author":"U S\u00f8holm","year":"2022","unstructured":"S\u00f8holm U, Broadley M, Zaremba N et al (2022) Investigating the day-to-day impact of hypoglycaemia in adults with type 1 or type 2 diabetes: design and validation protocol of the Hypo-METRICS application. BMJ Open 12(2):e051651. https:\/\/doi.org\/10.1136\/bmjopen-2021-051651","journal-title":"BMJ Open"},{"key":"6775_CR28","doi-asserted-by":"publisher","first-page":"e42100","DOI":"10.2196\/42100","volume":"8","author":"U S\u00f8holm","year":"2023","unstructured":"S\u00f8holm U, Zaremba N, Broadley M et al (2023) Assessing the content validity, acceptability, and feasibility of the Hypo-METRICS app: survey and interview study. JMIR Diabetes 8:e42100. https:\/\/doi.org\/10.2196\/42100","journal-title":"JMIR Diabetes"},{"issue":"3","key":"6775_CR29","doi-asserted-by":"publisher","first-page":"e0283148","DOI":"10.1371\/journal.pone.0283148","volume":"18","author":"U S\u00f8holm","year":"2023","unstructured":"S\u00f8holm U, Broadley M, Zaremba N et al (2023) Psychometric properties of an innovative smartphone application to investigate the daily impact of hypoglycemia in people with type 1 or type 2 diabetes: the Hypo-METRICS app. PLoS One 18(3):e0283148. https:\/\/doi.org\/10.1371\/journal.pone.0283148","journal-title":"PLoS One"},{"key":"6775_CR30","unstructured":"RStudio Team (2020) RStudio: integrated development for R. Available from: http:\/\/www.rstudio.com\/. Accessed: 10 Dec 2024"},{"key":"6775_CR31","doi-asserted-by":"publisher","first-page":"100153","DOI":"10.1016\/j.deman.2023.100153","volume":"12","author":"G Stoet","year":"2023","unstructured":"Stoet G, Holt RI (2023) Characteristics of people with optimally-managed type 1 diabetes. Diabetes Epidemiol Manag 12:100153. https:\/\/doi.org\/10.1016\/j.deman.2023.100153","journal-title":"Diabetes Epidemiol Manag"},{"issue":"6","key":"6775_CR32","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1111\/dom.12449","volume":"17","author":"A Kautzky-Willer","year":"2015","unstructured":"Kautzky-Willer A, Kosi L, Lin J, Mihaljevic R (2015) Gender-based differences in glycaemic control and hypoglycaemia prevalence in patients with type 2 diabetes: results from patient-level pooled data of six randomized controlled trials. Diabetes Obes Metab 17(6):533\u2013540. https:\/\/doi.org\/10.1111\/dom.12449","journal-title":"Diabetes Obes Metab"},{"issue":"11","key":"6775_CR33","doi-asserted-by":"publisher","first-page":"e48230","DOI":"10.1371\/journal.pone.0048230","volume":"7","author":"WE Mehling","year":"2012","unstructured":"Mehling WE, Price C, Daubenmier JJ, Acree M, Bartmess E, Stewart A (2012) The Multidimensional Assessment of Interoceptive Awareness (MAIA). PLoS One 7(11):e48230. https:\/\/doi.org\/10.1371\/journal.pone.0048230","journal-title":"PLoS One"},{"issue":"3","key":"6775_CR34","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1093\/ageing\/afw229","volume":"46","author":"SAP Clouston","year":"2017","unstructured":"Clouston SAP, Manganello JA, Richards M (2017) A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability. Age Ageing 46(3):493\u2013499. https:\/\/doi.org\/10.1093\/ageing\/afw229","journal-title":"Age Ageing"},{"issue":"2","key":"6775_CR35","doi-asserted-by":"publisher","first-page":"374","DOI":"10.3390\/jpm13020374","volume":"13","author":"E Gamarra","year":"2023","unstructured":"Gamarra E, Trimboli P (2023) Menstrual cycle, glucose control and insulin sensitivity in type 1 diabetes: a systematic review. J Pers Med 13(2):374. https:\/\/doi.org\/10.3390\/jpm13020374","journal-title":"J Pers Med"},{"issue":"4","key":"6775_CR36","doi-asserted-by":"publisher","first-page":"578","DOI":"10.4093\/dmj.2021.0135","volume":"46","author":"S Kang","year":"2022","unstructured":"Kang S, Park YM, Kwon DJ et al (2022) Reproductive life span and severe hypoglycemia risk in postmenopausal women with type 2 diabetes mellitus. Diabetes Metab J 46(4):578\u2013591. https:\/\/doi.org\/10.4093\/dmj.2021.0135","journal-title":"Diabetes Metab J"},{"issue":"3","key":"6775_CR37","doi-asserted-by":"publisher","first-page":"435","DOI":"10.2337\/dc25-2242","volume":"49","author":"AM Matus","year":"2026","unstructured":"Matus AM, Agni A, Amiel SA et al (2026) Interoceptive awareness moderates the relationship between hypoglycemia exposure and symptom recognition in adults with type 1 diabetes. Diabetes Care 49(3):435\u2013443. https:\/\/doi.org\/10.2337\/dc25-2242","journal-title":"Diabetes Care"},{"key":"6775_CR38","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.concog.2016.11.002","volume":"48","author":"A Grabauskait\u0117","year":"2017","unstructured":"Grabauskait\u0117 A, Baranauskas M, Gri\u0161kova-Bulanova I (2017) Interoception and gender: what aspects should we pay attention to? Conscious Cogn 48:129\u2013137. https:\/\/doi.org\/10.1016\/j.concog.2016.11.002","journal-title":"Conscious Cogn"},{"issue":"6","key":"6775_CR39","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1111\/dme.13333","volume":"34","author":"SM Harris","year":"2017","unstructured":"Harris SM, Shah P, Mulnier H et al (2017) Factors influencing attendance at structured education for type 1 diabetes in south London. Diabet Med 34(6):828\u2013833. https:\/\/doi.org\/10.1111\/dme.13333","journal-title":"Diabet Med"},{"issue":"6","key":"6775_CR40","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1016\/S0015-0282(16)56398-5","volume":"60","author":"RS Sherwin","year":"1993","unstructured":"Sherwin RS (1993) Counter-regulatory response to hypoglycemia in the follicular and luteal phases of the menstrual cycle. Fertil Steril 60(6):988\u2013993","journal-title":"Fertil Steril"},{"issue":"4","key":"6775_CR41","doi-asserted-by":"publisher","first-page":"2772","DOI":"10.3390\/ijerph20042772","volume":"20","author":"S Toor","year":"2023","unstructured":"Toor S, Yardley JE, Momeni Z (2023) Type 1 diabetes and the menstrual cycle: where\/how does exercise fit in? Int J Environ Res Public Health 20(4):2772. https:\/\/doi.org\/10.3390\/ijerph20042772","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"6775_CR42","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.metabol.2005.09.006","volume":"55","author":"JP Bremer","year":"2006","unstructured":"Bremer JP, Baron M, Peters H et al (2006) Hormonal, subjective, and neurocognitive responses to brief hypoglycemia in postmenopausal women and age-matched men with type 2 diabetes mellitus. Metabolism 55(3):331\u2013338. https:\/\/doi.org\/10.1016\/j.metabol.2005.09.006","journal-title":"Metabolism"},{"issue":"7","key":"6775_CR43","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.2337\/dc05-2069","volume":"29","author":"J Geddes","year":"2006","unstructured":"Geddes J, Warren RE, Sommerfield AJ et al (2006) Absence of sexual dimorphism in the symptomatic responses to hypoglycemia in adults with and without type 1 diabetes. Diabetes Care 29(7):1667\u20131669. https:\/\/doi.org\/10.2337\/dc05-2069","journal-title":"Diabetes Care"},{"key":"6775_CR44","doi-asserted-by":"publisher","first-page":"630109","DOI":"10.3389\/fgene.2021.630109","volume":"12","author":"S Kaur","year":"2021","unstructured":"Kaur S, Mirza AH, Overgaard AJ, Pociot F, St\u00f8rling J (2021) A dual systems genetics approach identifies common genes, networks, and pathways for type 1 and 2 diabetes in human islets. Front Genet 12:630109. https:\/\/doi.org\/10.3389\/fgene.2021.630109","journal-title":"Front Genet"},{"issue":"5","key":"6775_CR45","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1007\/s00592-024-02239-8","volume":"61","author":"TW Fabricius","year":"2024","unstructured":"Fabricius TW, Verhulst CEM, Kristensen PL et al (2024) Counterregulatory hormone and symptom responses to hypoglycaemia in people with type 1 diabetes, insulin-treated type 2 diabetes or without diabetes: the Hypo-RESOLVE hypoglycaemic clamp study. Acta Diabetol 61(5):623\u2013633. https:\/\/doi.org\/10.1007\/s00592-024-02239-8","journal-title":"Acta Diabetol"},{"issue":"3","key":"6775_CR46","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1530\/acta.0.1260264","volume":"126","author":"H Vea","year":"1992","unstructured":"Vea H, Jorde R, Sager G, Vaaler S, Sundsfjord JH (1992) The effect of selective \u03b21-blockade on glucose thresholds for release of counterregulatory hormones and symptoms in insulin-dependent diabetes mellitus. Acta Endocrinol 126(3):264\u2013270. https:\/\/doi.org\/10.1530\/acta.0.1260264","journal-title":"Acta Endocrinol"},{"issue":"Suppl 2","key":"6775_CR47","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1089\/dia.2015.0417","volume":"18","author":"D Rodbard","year":"2016","unstructured":"Rodbard D (2016) Continuous glucose monitoring: a review of successes, challenges, and opportunities. Diabetes Technol Ther 18(Suppl 2):S3\u2013S13. https:\/\/doi.org\/10.1089\/dia.2015.0417","journal-title":"Diabetes Technol Ther"},{"key":"6775_CR48","doi-asserted-by":"publisher","first-page":"108750","DOI":"10.1016\/j.diabres.2021.108750","volume":"174","author":"P Falcetta","year":"2021","unstructured":"Falcetta P, Aragona M, Ciccarone A et al (2021) Impact of COVID-19 lockdown on glucose control of elderly people with type 2 diabetes in Italy. Diabetes Res Clin Pract 174:108750. https:\/\/doi.org\/10.1016\/j.diabres.2021.108750","journal-title":"Diabetes Res Clin Pract"}],"container-title":["Diabetologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-026-06775-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00125-026-06775-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-026-06775-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:30:04Z","timestamp":1785472204000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00125-026-06775-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,20]]},"references-count":48,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["6775"],"URL":"https:\/\/doi.org\/10.1007\/s00125-026-06775-6","relation":{},"ISSN":["0012-186X","1432-0428"],"issn-type":[{"value":"0012-186X","type":"print"},{"value":"1432-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,20]]},"assertion":[{"value":"12 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors thank the people living with diabetes who participated in the Hypo-METRICS study. The authors also thank the Hypo-RESOLVE consortium: M. L. Evans, D. Chapman and J. Kennet (University of Cambridge); B. E. de Galan (Maastricht University); S. Heller, S. Caunt, S. Hudson, C. Husband and F. Arshad (University of Sheffield); R. J. McCrimmon, A. Barnett and J. Lindsay (University of Dundee); U. Pedersen-Bjergaard (University of Copenhagen); E. Renard, A. Farret, A. M. Marteil-Oudrer, M. Shbat, L. Crespy and J. Constanza Thibout (University of Montpellier); A. Pernet, A. Aldridge and M. Henderson-Wilson (King\u2019s College London); A. A. Vaag (Steno Diabetes Centre); P. Banck-Petersen, R. Carstensen and C. Hansen (Nordsj\u00e6llands Hospital Hiller\u00f8d); A. Rasing, J. Walburgh Schimidt, D. Loewenstein, R. Huijsmans, N. Ali, E. J. Abbink and P. Drijver (Radboud University Medical Centre); Z. Mahmoudi (University of Leicester); M. Cigler (Medical University of Graz); and J. Br\u00f8sen (Copenhagen University Hospital). The authors also thank Abbott Diabetes Care for providing the CGM devices used in the study and uMotif Limited for providing the platform for the Hypo-METRICS app. Some of the data included in this paper have been presented as abstracts at the Irish Endocrine Society Annual Meeting in 2025 and the Advanced Technologies and Treatments for Diabetes Meeting in 2026.","order":1,"name":"Ethics","label":"Acknowledgements","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Data are accessible by application to the Hypo-RESOLVE data access committee (Pratik Choudhary [pratik.choudhary@leicester.ac.uk] or Bastiaan de Galen [Bastiaan.deGalan@radboudumc.nl]). Restrictions apply to the use of these data in accordance with participant consent, privacy regulations and data-sharing agreements.","order":2,"name":"Ethics","label":"Data availability","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Hypo-RESOLVE received funding from the Innovative Medicines Initiative\u00a02 Joint Undertaking (JU) under grant agreement no. 777460 for the Hypo-METRICS study. The funder had no role in project design, data collection or analysis, manuscript development, or the decision to submit for publication. AM is supported by funding grants from St Vincent's Private Hospital, Dublin, and St Columcille's Hospital, Dublin, via the Newman fellowship.","order":3,"name":"Ethics","label":"Funding","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"SAA has served on advisory boards for Novo Nordisk and Medtronic and has spoken at educational events sponsored by Novo Nordisk and Sanofi. PC has received personal fees from Abbott Diabetes Care, Insulet, Dexcom, Novo Nordisk, AstraZeneca, Medtronic, Roche Diabetes Care and Sanofi Diabetes, and research funding support from Abbott Diabetes Care, Medtronic and Novo Nordisk. PD has spoken at education events sponsored by Novo Nordisk. JKM is a member of the advisory boards of Boehringer Ingelheim, Eli Lilly, Medtronic, Novo Nordisk AS, Prediktor A\/S, Roche Diabetes Care and Sanofi-Aventis Deutschland GmbH, and has received speaker honoraria from Abbott Diabetes Care, AstraZeneca, Dexcom, Eli Lilly, Medtronic, MSD, Novo Nordisk AS, Roche Diabetes Care, Sanofi, Servier and Takeda. She is a shareholder of decide Clinical Software GmbH and elyte diagnostics. FP has received funding for research from Novo Nordisk, Eli Lilly and Sanofi-Aventis Deutschland GmbH. The remaining authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","label":"Authors\u2019 relationships and activities","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"All authors made substantial contributions to the conception and design of this manuscript. AM, PD, GK and PC developed the plan for this manuscript, with input and advice from the remaining co-authors. JT, GME, EA and NZ advised on the analysis plan, and AM conducted all analyses. AM prepared the first manuscript draft, with critical feedback from PD, PC, SAA, JKM and FP. AM prepared subsequent revisions with feedback from all authors. All authors approved the final draft of the manuscript. AM is the guarantor of this work and takes responsibility for the integrity of the data and the accuracy of the data analysis.","order":5,"name":"Ethics","label":"Contribution statement","group":{"name":"EthicsHeading","label":"Ethics"}}]}}