Risk factors for hypoglycemia in patients with type 2 diabetes mellitus: a systematic review and meta-analysis.

INTRODUCTION: This systematic review and meta-analysis aimed to identify risk factors for hypoglycemia in adults with type 2 diabetes. METHODS: We searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and SinoMed from inception to July 8, 2026. Observational studies reporting risk factors for hypoglycemia were included. Study quality was assessed using the Newcastle-Ottawa Scale or AHRQ checklist. Odds ratios (ORs) were pooled using random- or fixed-effects models. RESULTS: Ten studies (n = 4,945; hypoglycemia 1,647; non- hypoglycemia 3,298) were included. Longer diabetes duration (OR 2.67, 95% CI 1.81-3.95), insulin therapy (OR 2.46, 95% CI 1.93-3.15), comorbidities (OR 1.79, 95% CI 1.17-2.75), and polypharmacy (OR 4.73, 95% CI 3.07-7.30) were associated with higher odds of hypoglycemia. Higher HbA1c (OR 0.59, 95% CI 0.44-0.81) and self- monitoring of blood glucose (OR 0.52, 95% CI 0.49-0.56) were associated with lower odds. Body mass index showed a non- significant inverse association (OR 0.69, 95% CI 0.47-1.03). Heterogeneity varied across factors, and small- study effects were suggested for comorbidities. DISCUSSION: These findings highlight interacting disease- , treatment- , and management- related determinants of hypoglycemia risk and may inform individualized risk assessment, although prospective studies are needed to validate these observations. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251146701.