Severe Hypoglycemia and Impaired Awareness of Hypoglycemia Persist in People With Type 1 Diabetes Despite Use of Diabetes Technology: Results From a Cross-sectional Survey

Abstract

Objective: To determine how diabetes technologies, including continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems, impact glycemic metrics, prevalence of severe hypoglycemic events (SHEs), and impaired awareness of hypoglycemia (IAH) in people with type 1 diabetes in a real-world setting within the U.S.

Research design and methods: In this retrospective, observational study with cross-sectional elements, participants aged ≥18 years were enrolled from the T1D Exchange Registry/online community. Participants completed a one-time online survey describing glycemic metrics, SHEs, and IAH. The primary objective was to determine the proportions of participants who reported achieving glycemic targets (assessed according to self-reported hemoglobin A1c) and had SHEs and/or IAH. We performed additional subgroup analyses focusing on the impact of CGM and insulin delivery modality.

Results: A total of 2,074 individuals with type 1 diabetes were enrolled (mean ± SD age 43.0 ± 15.6 years and duration of type 1 diabetes 26.3 ± 15.3 years). The majority of participants (91.7%) were using CGM, with one-half (50.8%) incorporating AID. Despite high use of diabetes technologies, only 57.7% reported achieving glycemic targets (hemoglobin A1c <7%). SHEs and IAH still occurred, with ∼20% of respondents experiencing at least one SHE within the prior 12 months and 30.7% (95% CI 28.7, 32.7) reporting IAH, regardless of CGM or AID use.

Conclusions: Despite use of advanced diabetes technologies, a high proportion of people with type 1 diabetes do not achieve glycemic targets and continue to experience SHEs and IAH, suggesting an ongoing need for improved treatment strategies.

Graphical abstract

Figure 1

Study schema: observational, cross-sectional study with enrollment of adults (aged ≥18 years) with a diagnosis of type 1 diabetes for ≥2 years from the T1D Exchange Registry or online communities. *CGM + pump subgroup includes participants who used CGM and conventional pumps (n = 574), those with unknown pump type (n = 9), and those who used CGM and AID pumps (n = 953).

Figure 2

Proportion of participants in the total survey sample reporting SHEs in the past 12 months (A), one or more and two or more SHEs (B), and IAH (C). Error bars represent 95% CIs. The dotted line corresponds to the value of the total survey sample. *SHE was defined as a hypoglycemic event in the past 12 months where the patient experienced low blood glucose levels that they were unable to treat themselves and needed help from others. †Nine CGM users with pump type unknown. ‡Modified Gold score ≥4.

Figure 3

Proportion of participants in the total survey sample with one or more SHEs and IAH (A) or two or more SHEs and IAH (B). Error bars represent 95% CIs. The dotted line corresponds to the value of the total survey sample. *Nine CGM users with pump type unknown. †SHE was defined as a hypoglycemic event in the past 12 months where the patient experienced low blood glucose levels that they were unable to treat themselves and needed help from others.