![]() Several risk factors have been associated with nocturnal hypoglycemia including demographic and non-demographic factors: age, race, BMI, comorbidities, stress, and diabetic nephropathy physical exercise – with greater risk associated with evening exercise tight glycemic control excessive insulin concentration during the day previous episodes of nocturnal hypoglycemia and low bedtime glucose levels (2, 7, 8). In addition to the increased risk for future episodes, the daytime effects after an episode of nocturnal hypoglycemia, such as fatigue, impaired mood and higher calorie intake and weight gain, considerably lower quality of life (5). Detection of nocturnal hypoglycemia is critically important if recurrent and undetected, even mild asymptomatic episodes can lead to further impairment of defenses against future episodes due to hypoglycemia-associated autonomic failure and defective counterregulatory responses to subsequent events (4, 6). Unless severe and followed by a seizure, coma, or other noticeable impairment at the awakening time, it can go unrecognized and be prolonged in patients with type 1 diabetes, and in worst cases, can lead to ‘dead-in-bed’ syndrome (5). Nocturnal hypoglycemia is often asymptomatic due to a sleep-induced effect that shifts the counterregulatory activation to hypoglycemia to a lower threshold(4, 5). Although the definition varies, nocturnal hypoglycemia is usually defined by a predetermined time window for which the international consensus recommendation is from midnight to 6 am, a period that usually includes the duration of nighttime sleep and the longest interprandial interval (1, 4). Over half of hypoglycemic episodes occur during nocturnal sleep with a higher prevalence for insulin-dependent diabetes patients that include patients with type 1 diabetes (i.e., insulin dependent) more so than type 2 diabetes (2, 3). Hypoglycemia – typically defined as a blood glucose (BG) below <70 mg/dL– is one of the acute complications of diabetes in patients treated with insulin (1). Additional study and specific patient-specific features will provide refinements that further ensure safe overnight management of glycemia. ![]() While instabilities and the absence of late-night blood glucose patterns introduce predictability challenges, this 6-hour horizon model demonstrates good performance in predicting nocturnal hypoglycemia. The model demonstrated an overall nighttime hypoglycemia prediction performance of ROC AUC = 0.84, with AUC = 0.90 for early night (midnight-3 am) and AUC = 0.75 for late night (prediction at midnight, looking at 3-6 am window). ![]() To this end, a nocturnal hypoglycemia prediction model with a 6-hour horizon (midnight-6 am) was developed using a random forest machine- learning model based on data from 10,000 users with more than 1 million nights of CGM data. Continuous glucose monitoring (CGM) devices have enabled prediction of impending nocturnal hypoglycemia, however, prior efforts have been limited to a short prediction horizon (~ 30 minutes). ![]() Nocturnal hypoglycemia is a serious complication of insulin-treated diabetes, which commonly goes undetected. ![]()
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