135-OR: Impaired Awareness of Hypoglycemia Is Associated with Residual Beta-Cell Function and Glucose Variability Parameters in Patients with Type 1 Diabetes

Abstract

The Aim: to evaluate the relationships between impaired awareness of hypoglycemia (IAH), residual beta cell function and short-term glucose variability (GV) in patients with type 1 diabetes (T1D). Materials and Methods: We observed 400 patients, 145 M/255 F, age 18-85 years (median - 36 years), diabetes duration 0.5-52 years (median - 16 years), HbA1c 4.7-15.1% (median - 8%). The Clarke's questionnaire was used for IAH recognition. Beta cell function was estimated by fasting and 2-h postprandial C-peptide levels. Day-time (6.00-23.59), nocturnal (0.00-5.59) and 24-h Time In target Range (TIR), Time Above target Range (TAR), Time Below target Range (TBR), and GV parameters, including Standard Deviation (SD), Coefficient of Variation (CV), Mean Amplitude of Glucose Excursions (MAGE), 2-h Continuous Overlapping Net Glycemic Action (CONGA), Lability Index (LI), J-index, Low Blood Glucose Index (LBGI), High Blood Glucose Index (HBGI), M-value and Mean Absolute Glucose (MAG), were calculated from short-term (3-7 days) continuous glucose monitoring (CGM). Results: In our cohort, IAH was recognized in 163 (40.8%) individuals. Patients with IAH, as compared to those without, demonstrated longer diabetes duration (P<0.0001), lower C-peptide postprandial level and increment (p=0.02 and p=0.0003 respectively) and increased day-time and nocturnal mean glucose, SD, CONGA, J-index, HBGI and M-value (all P≤0.02). Nocturnal MAGE, LI and LBGI, as well as 24-h mean glucose, SD, CV, MAGE, CONGA, J-index, HBGI, and M-value were also higher in patients with IAH (all P≤0.01). No differences in HbA1c, TIR, TAR and TBR were found between the groups. Day-time, nocturnal and 24-h SD, CV, LI, J-index, and HBGI, as well as day-time and 24-h MAGE, correlated negatively with postprandial C-peptide. Conclusion: In patients with T1D, IAH is associated with low (or zero) residual beta cell function. This relationship could be mediated via enhanced GV. Disclosure V. Klimontov: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Sanofi, Research Support; Self; Boehringer Ingelheim International GmbH, Speaker’s Bureau; Self; AstraZeneca, Medtronic. J. F. Semenova: None. A. I. Korbut: None. Funding Russian Science Foundation (20-15-00057)