Characterizing Severe and Level 2 Hypoglycemia and Associated Risk Factors in Adults with Type 1 Diabetes Using...

Area of Science:

• Endocrinology
• Diabetes Technology
• Metabolic Disorders

Background:

• Severe hypoglycemia (SH) and level 2 hypoglycemia (Lv2Hypo) remain challenges for hybrid closed-loop (HCL) insulin pump users despite technological advancements.
• Understanding factors contributing to these events is crucial for improving patient safety and diabetes management.

Purpose of the Study:

• To investigate the association between impaired awareness of hypoglycemia (IAH) and other patient characteristics with SH and Lv2Hypo in adults with type 1 diabetes using HCL insulin pumps.
• To identify risk factors for hypoglycemia in this population.

Main Methods:

• A cross-sectional survey was conducted among 601 adult HCL insulin pump users from a U.S. type 1 diabetes patient registry.
• Data collected included 6-month SH history, hemoglobin A1C, IAH via the Hypoglycemia Awareness Questionnaire, and 30-day continuous glucose monitoring (CGM) data.
• Statistical analyses included logistic regression, t-tests, and Chi-square tests.

Main Results:

• IAH and higher glucose coefficients of variation (CVs) were significantly associated with both SH and spending ≥1% of time in Lv2Hypo (P < 0.05).
• Individuals experiencing SH also showed increased time with glucose levels >180 mg/dL and >250 mg/dL, and lower education levels (P < 0.05).
• CGM hypoglycemia measures, age, and diabetes duration were not associated with SH or Lv2Hypo. Hyperglycemia and lower education were linked to higher SH risk.

Conclusions:

• IAH and elevated glucose CVs are significant risk factors for SH and Lv2Hypo in type 1 diabetes patients using HCL insulin pumps.
• Hyperglycemia and lower educational attainment are also associated with an increased risk of severe hypoglycemia.
• These findings highlight the importance of assessing IAH and glucose variability for optimizing HCL therapy and preventing hypoglycemic events.