Prevalence, Awareness and Correlates of Self-Reported Hypoglycemia Among Adults with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study

Hypoglycemia is a frequent and potentially dangerous adverse effect of glucose-lowering therapy in type 2 diabetes mellitus (T2DM), yet data on its prevalence, patient awareness and correlates in Jordan are limited. We conducted a cross-sectional study of 326 adults with T2DM attending family medicine outpatient clinics at a tertiary teaching hospital (King Abdullah University Hospital, KAUH) and a university-affiliated primary healthcare center (JUST PHC) in northern Jordan between 2025 and 2026. Trained interviewers administered a structured questionnaire, and laboratory results were verified from electronic medical records. Hypoglycemia was defined as a glucose level below 70 mg/dL or symptoms relieved by fast-acting carbohydrate during the preceding six months. Prevalence was estimated with 95% confidence intervals, and associated factors were examined using chi-square tests and multivariable logistic regression. The prevalence of self-reported hypoglycemia was 79.1% (258/326; 95% CI 74.4-83.2). Although 71.5% of participants knew the symptoms of hypoglycemia, 73.9% were unaware that it can occur without symptoms, 53.6% had never reported an episode to a healthcare provider, only 31.3% had discussed hypoglycemia risk with a physician, and 50.6% never carried sugar or an emergency kit. In the multivariable model, insulin use (adjusted odds ratio [aOR] 3.27, 95% CI 1.75-6.10), sulfonylurea use (aOR 2.14, 1.18-3.87), diabetic nephropathy (aOR 3.76, 1.05-13.48) and attending the primary healthcare center versus the hospital (aOR 2.76, 1.42-5.36) were independently associated with higher odds of hypoglycemia, whereas beta-blocker use was associated with lower odds (aOR 0.52, 0.28-0.95). Self-reported hypoglycemia was highly prevalent among patients with T2DM in northern Jordan, and awareness of asymptomatic hypoglycemia and reporting to providers were limited. Routine structured enquiry about hypoglycemia, patient education that addresses asymptomatic episodes, and review of high-risk therapy, particularly in primary care, are warranted.