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

OBJECTIVE To determine how diabetes technologies, including continuous glucose monitoring and automated insulin delivery 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 US. RESEARCH DESIGN AND METHODS This retrospective, observational study with cross-sectional elements enrolled participants aged ≥18 years 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 (as assessed by self-reported hemoglobin A1c) and had SHEs and/or IAH. Additional subgroup analyses were performed focusing on the impact of continuous glucose monitoring and insulin delivery modality. RESULTS 2,074 individuals with type 1 diabetes were enrolled (mean ± SD age: 43.0 ± 15.6 years; duration of type 1 diabetes: 26.3 ± 15.3 years). The majority of participants (91.7%) were using continuous glucose monitoring with one-half (50.8%) incorporating automated insulin delivery. Despite high use of diabetes technologies, only 57.7% reported achieving glycemic targets (hemoglobin A1c <7%). SHE and IAH still occurred, with approximately 20% of respondents experiencing at least one SHE within 12 months and 30.7% (95% CI: 28.7, 32.7) reporting IAH, regardless of continuous glucose monitoring or automated insulin delivery use. CONCLUSIONS Despite use of advanced diabetes technologies, a high proportion of people with type 1 diabetes don’t achieve glycemic targets and continue to experience SHEs and IAH, suggesting an ongoing need for improved treatment strategies.