367-P: Clinical Characteristics of Type 1 Diabetes and Severe Hypoglycemia in Adult Continuous Glucose Monitor Users

Introduction & Objective: Recurrent severe hypoglycemic events (SHE) are associated with impaired awareness of hypoglycemia (IAH). This study describes the demographic and clinical characteristics of adults with type 1 diabetes (T1D) and SHE/IAH.

Methods: Adult (≥18 years) continuous glucose monitor (CGM) users from the T1D Exchange Registry with self-reported T1D diagnosis ≥5 years completed an online survey with clinical and demographic characteristics. SHE cohorts were created based on SHE frequency in the past 12 months and the presence/absence of IAH (Modified Gold Score): problematic SHE (2+ SHE/IAH-; 1+ SHE/IAH+) and no SHE (0 SHE/IAH+; 0 SHE/IAH-). Participant characteristics were descriptively summarized (mean, standard deviation [SD]).

Results: A total of 1,847 T1D CGM users responded. The problematic SHE cohort (n=375) compared with the no SHE cohort (n=1,033) were older (age 49.0 vs. 45.6 years), more racially diverse (86.4% vs. 92.7% Caucasian), had lower levels of employment (58.4% vs. 71.2%), increased report of lower income <$50,000 (25.1% vs. 16.9%), and more often reported Medicaid as their primary health insurance (10.4% vs. 3.1%). The problematic SHE cohort reported longer duration of T1D (31.9 [SD 16.0] vs. no SHE 28.6 [SD 14.8]), lower insulin pump use (78.4% vs. 85.9%), slightly higher recent HbA1c (6.9 [SD 1.1] vs. 6.6 [SD 0.9]), with more participants with HbA1c ≥7% (42.4% vs. 31.3%). More T1D-related complications were reported in the problematic SHE vs. no SHE cohort (retinopathy 28.3% vs. 21.5%; neuropathy 24.5% vs. 10.5%; nephropathy 8.3% vs. 4.5%; gastroparesis 19.5% vs. 6.5%; and cardiovascular disease 12.5% vs. 5.5%). Based on BMI calculated from reported height and weight, >60% of participants were overweight or obese across all cohorts.

Conclusion: Findings suggest those who experience SHE have higher clinical burden and lower socioeconomic status, highlighting the need for innovative approaches to management for these individuals.