Introduction: Severe hypoglycemia is an ongoing barrier to achieving glycemic targets. Glucagon is an effective, yet underutilized treatment for severe hypoglycemia. This study characterized the emotional impact of severe hypoglycemia, glucagon perceptions, and barriers to glucagon use for people with T1D.

Methods: Participants included individuals recruited from the T1D Exchange online community. The current study conducted 7 focus groups consisting of adults with T1D (n = 38, average age 49.4, SD = 16.11 years). Average duration of diabetes was 34.4 years (SD = 17.3) and average self-reported A1c was 6.8% (SD = 0.7). Focus groups were recorded, transcribed, and thematically analyzed.

Results: A range of emotions was expressed about severe hypoglycemia including fear, anxiety, stress, frustration, shame, and embarrassment. Due to hypoglycemia unawareness, participants discussed relying on CGM to make hypoglycemia treatment decisions. Multiple participants self-administered glucagon to prevent or treat a severe hypoglycemic event. Although overnight hypoglycemia and CGM alarms were described as important, some participants also viewed them as sleep disruptors for themselves and their partners. Participants frequently identified prescription cost and insurance deductibles as barriers to glucagon use. Participants were also concerned about ease of administration—how difficult it is to prepare the glucagon in an emergency situation. Many participants expressed a preference for auto-injectables over nasal administration. Timing of glucagon action and time to recovery were high priorities. Some participants, while they had not self-administered glucagon, were interested in a mini-dose glucagon they could self-administer.

Conclusions: These results provide insight into the real-world impact of diabetes management in persons with T1D and highlight the attitudes about severe hypoglycemia and emergency glucagon treatment.

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