Predictors of Impaired Awareness of Hypoglycemia in Adults with Type 1 Diabetes

Background: Impaired awareness of hypoglycemia (IAH) is associated with a substantially increased risk of severe hypoglycemia (SH) in type 1 diabetes. Risk factors for IAH are not well characterized in the modern context. We assessed associations with IAH in adults with type 1 diabetes. Methods: Cross-sectional observational study. 782/2210 (35.4%) of people with type 1 diabetes attending a UK diabetes center completed a questionnaire with questions on hypoglycemia awareness and mental health. Data were also extracted for CGM metrics and additional clinical and demographic information. Results: 54.1% of participants were men. Median age was 51 years and diabetes duration was 24 years. 27.0% were on CSII. 88.6% were using CGM. IAH (Gold score ≥ 4) was present in 21.3%. 10.0% had a hypoglycemia awareness threshold less than 3.0 mM (54mg/dl). 5.1% gave a recent history of severe hypoglycemia. IAH associations are presented in the table. PHQ-2 depression screen positive (HR 2.1, p = 0.009), socioeconomic deprivation (HR 1.8, p = 0.006) and female sex (HR 1.8, p = 0.002) were independently associated with IAH. Discussion: IAH, as defined by elevated Gold Score, was associated with a near four-fold increased risk of SH. Psychological approaches to IAH have shown promise and these data highlight the importance of adequate mental health screening, especially in IAH. Disclosure F.W.Gibb: Advisory Panel; Abbott. R.H.Stimson: None. S.Forbes: None. A.R.Dover: Other Relationship; Abbott Diabetes.