{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:04:03Z","timestamp":1784541843769,"version":"3.55.0"},"reference-count":47,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:00:00Z","timestamp":1715558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000361","name":"Diabetes UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000361","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Impaired awareness of hypoglycaemia (IAH) increases the risk of severe hypoglycaemia in people with type 1 diabetes mellitus (T1DM). IAH can be reversed through meticulous avoidance of hypoglycaemia. Diabetic autonomic neuropathy (DAN) has been proposed as an underlying mechanism contributing to IAH; however, data are inconsistent. The aim of this study was to examine the effects of cardiac autonomic neuropathy (CAN) on IAH reversibility inT1DM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants with T1DM and IAH (Gold score \u22654) recruited to the HypoCOMPaSS (24\u2010week 2\u2009\u00d7\u20092 factorial randomised controlled) trial were included. All underwent screening for cardiac autonomic function testing at baseline and received comparable education and support aimed at avoiding hypoglycaemia and improving hypoglycaemia awareness. Definite CAN was defined as the presence of \u22652 abnormal cardiac reflex tests. Participants were grouped according to their CAN status, and changes in Gold score were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighty\u2010three participants (52 women [62.7%]) were included with mean age (SD) of 48 (12) years and mean HbA1c of 66 (13) mmol\/mol (8.2 [3.3] %). The mean duration of T1DM was 29 (13) years. The prevalence of CAN was low with 5\/83 (6%) participants having definite autonomic neuropathy with 11 (13%) classified with possible\/early neuropathy. All participants, regardless of the autonomic function status, showed a mean improvement in Gold score of \u22651 (mean improvement \u22121.2 [95% CI \u22120.8, \u22121.6]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>IAH can be improved in people with T1DM, and a long duration of disease, with and without cardiac autonomic dysfunction. These data suggest that CAN is not a prime driver for modulating IAH reversibility.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.15340","type":"journal-article","created":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T04:28:59Z","timestamp":1715660939000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diabetic autonomic neuropathy does not impede improvement in hypoglycaemia awareness in adults: Sub\u2010study results from the <scp>HypoCOMPaSS<\/scp> trial"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9932-0941","authenticated-orcid":false,"given":"Muhammad Fahad","family":"Arshad","sequence":"first","affiliation":[{"name":"University of Sheffield  Sheffield UK"},{"name":"Sheffield Teaching Hospitals NHS Foundation Trust  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Walkinshaw","sequence":"additional","affiliation":[{"name":"University of Sheffield  Sheffield UK"},{"name":"Sheffield Teaching Hospitals NHS Foundation Trust  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Lubina","family":"Solomon","sequence":"additional","affiliation":[{"name":"Russells Hall Hospital, Dudley Group Hospitals  Dudley UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Bernjak","sequence":"additional","affiliation":[{"name":"University of Sheffield  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Rombach","sequence":"additional","affiliation":[{"name":"University of Sheffield  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lala","family":"Leelarathna","sequence":"additional","affiliation":[{"name":"Department of Metabolism Digestion and Reproduction, Faculty of Medicine, Imperial College London  London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart A.","family":"Little","sequence":"additional","affiliation":[{"name":"Institute of Cellular Medicine Newcastle University  Newcastle UK"},{"name":"Newcastle upon Tyne Hospitals NHS Foundation Trust  Newcastle UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Evans","sequence":"additional","affiliation":[{"name":"MRC Institute of Metabolic Science University of Cambridge  Cambridge London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A. 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