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Interoceptive Awareness Moderates the Relationship Between Hypoglycemia Exposure and Symptom Recognition in Adults With Type 1 Diabetes

Lookup NU author(s): Professor James ShawORCiD

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Abstract

© 2026 by the American Diabetes Association.OBJECTIVE Hypoglycemia exposure lowers the glycemic threshold for symptom recognition, contributing to impaired awareness of hypoglycemia (IAH). Interoceptive aware-ness, the ability to sense and interpret internal bodily sensations, is associated with a lower risk of IAH. We tested the hypothesis that interoceptive awareness moderates the association between hypoglycemia exposure and glycemic threshold for autonomic symptom recognition. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes completed validated surveys assessing interocep-tive awareness (Multidimensional Assessment of Interoceptive Awareness, Version 2 [MAIA-2]) and the glycemic threshold for autonomic symptom recognition (Hypoglycemia Awareness Questionnaire Symptom Level subscale) and provided 30-day continuous glucose monitoring data. We used proportional odds logistic regression to examine whether the MAIA-2 Attention Regulation scale score (mea-suring the ability to sustain and control attention to bodily sensations) moderated the association between hypoglycemia exposure (percent time [%-time] <60 mg/dL) and symptom level, adjusting for covariates. RESULTS Among 717 participants (94% White, 52% female, mean [SD] age 44 [15] years; diabetes duration 25 [15] years; 17% with IAH), 30-day hypoglycemia exposure (%-time <60 mg/dL) was 0.8 (1.4%) (11.5 [20.2] min/day). Higher hypoglycemia exposure was associated with lower symptom levels (odds ratio [OR] 0.45; 95% CI 0.31, 0.66; P < 0.001). Interoceptive awareness alone was not associated with symptom level (OR 0.93; 95% CI 0.78, 1.12), but higher interoceptive awareness attenuated the association between hypoglycemia exposure and symptom level (OR 1.14; 95% CI 1.01, 1.27; P < 0.05). CONCLUSIONS Interoceptive awareness moderated the association between hypoglycemia exposure and glycemic threshold for symptom recognition. Research is needed to examine whether interventions can improve interoceptive awareness and, thereby, restore awareness of hypoglycemia.

Publication metadata

Author(s): Matus AM, Agni A, Amiel SA, Riegel B, Shaw JA, Speight J, Rickels MR, Lin YK

Publication type: Article

Publication status: Published

Journal: Diabetes Care

Year: 2026

Volume: 49

Issue: 3

Pages: 435-443

Print publication date: 01/03/2026

Online publication date: 30/12/2025

Acceptance date: 25/11/2025

ISSN (print): 0149-5992

ISSN (electronic): 1935-5548

Publisher: American Diabetes Association Inc.

URL: https://doi.org/10.2337/dc25-2242

DOI: 10.2337/dc25-2242

PubMed id: 41467850

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