A case-control study on factors associated with hypoglycemia unawareness among the ambulatory type 2 diabetes mellitus patients in Bali, Indonesia

Purpose: To determine the factors related to hypoglycemia unawareness (HU) in patients with type 2 diabetes mellitus (T2DM) in Bali-Indonesia. Methods: A case-control study was conducted across three hospitals to investigate the incidence of HU as a primary outcome. Medical record data were collected to obtain information for further analysis. The primary data were analyzed using chi-square analysis, and variables with p-value ⤠0.10 were further evaluated using multivariate logistic regression, with odds ratio (OR) parameters at 95 confidence interval (CI). A two-tailed statistical analysis was then conducted, and p < 0.05 was considered statistically significant. Results: Results of the multivariate analysis showed that five variables were significantly associated with HU incidents. These included insulin users (OR: 6.15 (CI 95: 1.65 - 22.86)), chronic kidney diseases (CKD) (OR: 6.56 (CI 95: 1.41 - 30.39)), diabetic neuropathy (OR: 24.61 (CI 95: 5.17 - 117.11)), hypertension (OR: 3.76 (CI 95: 1.01 - 13.96)), and dyslipidemia (OR: 6.44 (CI 95: 1.62 - 25.71)). Conclusion: Variables in this study are in line with the characteristics of the ambulatory T2DM population in Bali-Indonesia. These factors are used as evidence by health workers in managing and mitigating the risk of HU, thereby reducing the associated health burden. © 2025 The authors.