OBJECTIVES: The objective of the study was to understand of the impact of diabetes-related non-severe hypoglycemic episodes (NSHE’s) on work productivity and diabetes management. METHODS: A web-based survey was developed based on literature, expert input and 68 patients participating in focus-group or individual interviews. Persons with self-reported diabetes in US, France, Germany, and UK participated in the survey. NSHE’s were classified as occurring in the past month, either daytime (while at work or not at work) or during sleep. RESULTS: A total of 6756 persons were surveyed of whom 972 (14.4%) worked for pay and had a NSHE. The mean age of the sample was 41.3±13.5. There were no significant country differences for % on insulin vs. oral or % type1 vs. type 2 subjects. Fifty-nine percent of type 1 subjects (range 50.7% in France – 70.9% in US, p=0.001) and 34.8% of type 2 subjected (range 31.4% in US -38.1% in France, p=0.827) reported having a NSHE at least weekly.  Diabetes management was impacted as 20.9% of insulin dependent subjects reported decreasing their normal insulin dose on average 18.7 units per day over 3.2 days. Further, a mean of 7.0 extra blood glucose tests were conducted in the week following their last NSHE. For those whose last NSHE was at work (n=483), work productivity was impacted with 28.6% reported missing work (e.g., leaving early) due to this NSHE. For those whose last NSHE occurred during the day but outside of work (n= 368), 18.2% of respondents reported work absenteeism due to this NSHE. For those whose last NSHE was during sleep (n=121), 16.5% of respondents reported subsequent work absenteeism.  CONCLUSIONS: NSHE’s have a considerable impact on work loss productivity across these countries. The seriousness of NSHEs may be underestimated and should be considered an important part of diabetes management.