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However, real\u2010world insight into its incidence and risk factors remains limited. We analysed data from the iNPHORM study to address this gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>iNPHORM is a prospective internet panel survey of US adults (aged 18\u201390) with type 1 diabetes (T1D) or insulin\u2010 and\/or secretagogue\u2010treated type 2 diabetes (T2D). A screener, baseline and 12\u2010monthly follow\u2010up questionnaires captured data on Level 3 hypoglycaemia and participant characteristics. Crude incidence proportions and annualized event rates were calculated. Repeated LASSO selection and negative binomial regression identified risk factors, with separate models for T1D and T2D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 985 participants (T1D: 16.7%), 35.0% experienced \u22651 Level 3 event over follow\u2010up (T1D: 45.0%; T2D: 33.0%). The annualized rate was 4.98 EPPY (T1D: 3.56; T2D: 5.26). In T1D, rates were higher among individuals identifying as non\u2010White (RR [rate ratio]: 2.03), with prior diabetes ketoacidosis (RR: 6.49), and greater fear of hypoglycaemia (RR: 1.41). Prior diabetes education (RR: 0.42) was protective. In T2D, rates were higher with younger age (RR: 0.77 per 10\u2010year increase), greater fear of hypoglycaemia (RR: 1.18), more diabetes complications, higher secretagogue dose, more diabetes visits (RR: 1.72), longer use of continuous\/flash glucose monitoring, impaired awareness of hypoglycaemia and a greater number of past healthcare\u2010requiring severe hypoglycaemia (RR: 1.12).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Level 3 hypoglycaemia remains common in T1D and T2D. Findings support risk\u2010targeted prevention and diabetes care strategies that co\u2010prioritize safety and effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70252","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T17:30:52Z","timestamp":1762191052000},"page":"675-690","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Real\u2010world incidence and risk factors of level 3 (severe) hypoglycaemia in adults with type 1 or 2 diabetes (\n                    <scp>iNPHORM<\/scp>\n                    , United States)"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9474-7900","authenticated-orcid":false,"given":"Alexandria","family":"Ratzki\u2010Leewing","sequence":"first","affiliation":[{"name":"University of Maryland Institute for Health Computing  North Bethesda Maryland USA"},{"name":"Division of Gerontology, 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