Impaired awareness of hypoglycemia (IAH) is a prevalent issue among patients with Type 2 Diabetes Mellitus (T2DM). Recurrent hypoglycemic events may diminish hypoglycemia perception and elevate the risk of severe hypoglycemia. However, limited research have explored the prevalence and determinants of IAH in community-dwelling T2DM patients.

To investigate the prevalence of IAH and its influencing factors among community T2DM patients, providing scientific evidence for community health service institutions to optimize health management strategies.

This cross-sectional study adopted a multistage stratified random sampling method to select T2DM patients from 9 community health service centers (stations) in Fengtai District, Beijing. From May to August 2024, data on demographic characteristics, hypoglycemic experiences, hypoglycemia awareness, and diabetes self-management behaviors were collected via face-to-face questionnaires. The GOLD method was used to assess hypoglycemia awareness and diagnose IAH. Multivariate Logistic regression analysis was performed to identify the determinants of IAH.

Among 487 valid questionnaires, the self-reported prevalence of IAH was 27.1% (132/487). Multivariate Logistic regression analysis revealed that the independent risk factors for IAH were undiagnosed or unknown diabetes complications (OR=2.164, 95%CI=1.215-3.852) and achievement of glycated hemoglobin A_1c (HbA_1c) targets (OR=1.648, 95%CI=1.033-2.628). The independent protective factors included disease duration of 11-20 years (OR=0.320, 95%CI=0.152-0.672), disease duration≥20 years (OR=0.459, 95%CI=0.220-0.955), use of oral hypoglycemic agents (OR=0.052, 95%CI=0.01-0.274), insulin use (OR=0.199, 95%CI=0.050-0.803), no hypoglycemic medication use (OR=0.029, 95%CI=0.003-0.245), awareness of hypoglycemia diagnostic criteria (OR=0.498, 95%CI=0.265-0.935), having blood glucose monitoring tools with occasional use (OR=0.406, 95%CI=0.185-0.891), proficient and regular blood glucose monitoring (OR=0.410, 95%CI=0.173-0.974), and good tobacco control status (OR=0.498, 95%CI=0.272-0.909).

Stringent glycemic control and insufficient blood glucose monitoring knowledge are associated with increased IAH risk, whereas regular glucose monitoring, hypoglycemia awareness, and smoking cessation demonstrated protective effects. Community healthcare providers should implement comprehensive interventions targeting these modifiable factors, such as optimizing glucose monitoring protocols, strengthening health education, and promoting tobacco control, to reduce IAH incidence and improve patients' disease management outcomes and quality of life.