{"doi":"10.1111/dom.15186","title":"Development and validation of a real‐world model to predict 1‐year Level 3 (severe) hypoglycaemia risk in adults with diabetes (the\n                    <scp>iNPHORM</scp>\n                    study, United States)","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec>\n                    <jats:title>Aims</jats:title>\n                    <jats:p>We aimed to develop and internally validate a real‐world prognostic model for Level 3 hypoglycaemia risk compatible with outpatient care in the United States.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods</jats:title>\n                    <jats:p>iNPHORM is a 12‐month, US‐based panel survey. Adults (18‐90 years old) with type 1 diabetes mellitus or insulin‐ and/or secretagogue‐treated type 2 diabetes mellitus were recruited from a nationwide, probability‐based internet panel. Among participants completing 1 follow‐up questionnaire(s), we modelled 1‐year Level 3 hypoglycaemia risk using Andersen and Gill's Cox survival and penalized regression with multiple imputation. Candidate variables were selected for their clinical relevance and ease of capture at point‐of‐care.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>In total, 986 participants [type 1 diabetes mellitus: 17%; men: 49.6%; mean age: 51 (SD: 14.3) years] were analysed. Across follow‐up, 035.1 (95% CI: 32.2‐38.1)% reported ≥1 Level 3 event(s), and the rate was 5.0 (95% CI: 4.1‐6.0) events per person‐year. Our final model showed strong discriminative validity and parsimony (optimism corrected c‐statistic: 0.77). Numerous variables were selected: age; sex; body mass index; marital status; level of education; insurance coverage; race; ethnicity; food insecurity; diabetes type; glycated haemoglobin value; glycated haemoglobin variability; number, type and dose of various medications; number of SH events requiring hospital care (past year and over follow‐up); type and number of comorbidities and complications; number of diabetes‐related health care visits (past year); use of continuous/flash glucose monitoring; and general health status.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>iNPHORM is the first US‐based primary prognostic study on Level 3 hypoglycaemia. Future model implementation could potentiate risk‐tailored strategies that reduce real‐world event occurrence and overall diabetes burden.</jats:p>\n                  </jats:sec>","journal":"Diabetes, Obesity and Metabolism","year":2023,"id":615618,"datarank":0.29188652235829704,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.0,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1586879,"name":"Jason E. Black","orcid":"0000-0002-3762-3231","position":1,"is_corresponding":false},{"id":1586880,"name":"Bridget L. Ryan","orcid":null,"position":2,"is_corresponding":false},{"id":1529,"name":"Guangyong Zou","orcid":"0000-0001-5773-4185","position":3,"is_corresponding":false},{"id":1560642,"name":"Neil Klar","orcid":null,"position":4,"is_corresponding":false},{"id":1586885,"name":"Susan Webster‐Bogaert","orcid":null,"position":5,"is_corresponding":false},{"id":1586888,"name":"Kristina Timcevska","orcid":null,"position":6,"is_corresponding":false},{"id":1048470,"name":"Stewart B. Harris","orcid":"0000-0002-1794-6551","position":7,"is_corresponding":false},{"id":1586877,"name":"Alexandria A. Ratzki‐Leewing","orcid":"0000-0002-9474-7900","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Development and validation of a real‐world model to predict 1‐year Level 3 (severe) hypoglycaemia risk in adults with diabetes (the\n                    <scp>iNPHORM</scp>\n                    study, United States)","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec>\n                    <jats:title>Aims</jats:title>\n                    <jats:p>We aimed to develop and internally validate a real‐world prognostic model for Level 3 hypoglycaemia risk compatible with outpatient care in the United States.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods</jats:title>\n                    <jats:p>iNPHORM is a 12‐month, US‐based panel survey. Adults (18‐90 years old) with type 1 diabetes mellitus or insulin‐ and/or secretagogue‐treated type 2 diabetes mellitus were recruited from a nationwide, probability‐based internet panel. Among participants completing 1 follow‐up questionnaire(s), we modelled 1‐year Level 3 hypoglycaemia risk using Andersen and Gill's Cox survival and penalized regression with multiple imputation. Candidate variables were selected for their clinical relevance and ease of capture at point‐of‐care.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>In total, 986 participants [type 1 diabetes mellitus: 17%; men: 49.6%; mean age: 51 (SD: 14.3) years] were analysed. Across follow‐up, 035.1 (95% CI: 32.2‐38.1)% reported ≥1 Level 3 event(s), and the rate was 5.0 (95% CI: 4.1‐6.0) events per person‐year. Our final model showed strong discriminative validity and parsimony (optimism corrected c‐statistic: 0.77). Numerous variables were selected: age; sex; body mass index; marital status; level of education; insurance coverage; race; ethnicity; food insecurity; diabetes type; glycated haemoglobin value; glycated haemoglobin variability; number, type and dose of various medications; number of SH events requiring hospital care (past year and over follow‐up); type and number of comorbidities and complications; number of diabetes‐related health care visits (past year); use of continuous/flash glucose monitoring; and general health status.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>iNPHORM is the first US‐based primary prognostic study on Level 3 hypoglycaemia. Future model implementation could potentiate risk‐tailored strategies that reduce real‐world event occurrence and overall diabetes burden.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":1.791759469228055,"endowment":1.791759469228055,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"37409569","pmcid":null,"openalex_id":"https://openalex.org/W4383303146","authors":[],"funders":[],"total_grants":0,"fwci":0.7514,"citation_percentile":0.73071253,"influential_citations":0,"citation_trend":[{"year":2023,"count":1},{"year":2024,"count":1},{"year":2025,"count":3}],"oa_status":"hybrid","license":"cc-by-nc","oa_locations":[{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/dom.15186","host_type":"journal"},{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/dom.15186","host_type":"publisher"},{"url":"https://dom-pubs.pericles-prod.literatumonline.com/doi/pdf/10.1111/dom.15186","host_type":"publisher"},{"url":"https://doi.org/10.1111/dom.15186","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/37409569","host_type":"repository"}],"fields_of_study":["Diabetes Management and Research","Diabetes, Cardiovascular Risks, and Lipoproteins","Diabetes Treatment and Management"],"mesh_terms":["Adolescent","Adult","Aged","Aged, 80 and over","Blood Glucose","Diabetes Mellitus, Type 1","Diabetes Mellitus, Type 2","Glycated Hemoglobin","Humans","Hypoglycemia","Hypoglycemic Agents","Insulin","Male","Middle Aged","United States","Blood Glucose Self-Monitoring","Young Adult"],"keywords":["Medicine","Diabetes mellitus","Gerontology","Pediatrics","Environmental health","Endocrinology","Type 2 diabetes","type 1 diabetes","hypoglycaemia","Insulin Therapy","Insulin Secretagogue","Real-world Evidence"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Reduced inequalities"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-02T20:35:26.769865Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}