Persistent Burden of Severe Hypoglycemia and Impaired Awareness of Hypoglycemia Among People With Type 1 Diabetes Despite Technology Use: A Follow-up Survey 

Objective: To assess longitudinal trends in glycemic metrics, prevalence of severe hypoglycemic events (SHEs), impaired awareness of hypoglycemia (IAH), and technology use (continuous glucose monitoring [CGM], automated insulin delivery [AID]) in a real-world U.S. cohort of adults with type 1 diabetes.

Research design and methods: This was a cross-sectional study of adults with type 1 diabetes conducted ∼2 years after participants enrolled in the original retrospective observational study. Participants self-reported technology use, insulin delivery method, glycated hemoglobin (HbA1c), IAH, and SHEs. Change was assessed among these variables from the initial and follow-up study.

Results: Approximately 2 years after the original survey, 1,056 adults responded to the follow-up survey and were eligible for analysis (53% response rate; mean [SD] age: 46 [16] years; mean [SD] type 1 diabetes duration: 29 [16] years; 71% female; 97% White). Most reported using CGM in the original study (91.8%) and at follow-up (94.4%), while the use of AID increased 17.7%. In the original study, 61.7% reported HbA1c <7% vs. 67.4% at follow-up. Proportions of individuals with IAH and SHEs remained high at ∼30% and ∼20%, respectively, in both studies.

Conclusions: Although most participants used CGM and the use of AID increased, approximately one-third of respondents did not achieve HbA1c targets, ∼20% continued to have SHEs in the last year, and ∼30% had IAH. This highlights that while CGM and AID systems are a significant advancement, their use alone has not mitigated the risk of severe hypoglycemia, and glucose management still remains suboptimal.