136-OR: Nocturnal Hypoglycemia Prevention Strategies Used by People with Type 1 Diabetes According to Their Insulin Delivery and Blood Glucose Monitoring Technology

Abstract

People with T1D (PWT1D) use many strategies to avoid nocturnal hypoglycemia (NH), however, the current evidence on these strategies is limited. Technologies such as continuous subcutaneous insulin infusion (CSII) or continuous glucose monitors (CGM) could help reduce NH and possibly alter PWT1D’ management behaviors. Aim: To describe PWT1D’ preferred NH prevention strategies according to their use of technology. Methods: Self-reported data from an online registry of PWT1D were analyzed. To describe which NH prevention strategies are most often used, we ran a χ2 test with a post hoc pairwise comparison of the groups based on their mode of insulin delivery and glucose monitoring (CSII + self-monitoring of blood glucose (SMBG); CSII + CGM; multiple daily injections (MDI) + CGM; MDI + SMBG). Results: Among 767 adults (64% female, mean age 45 ± 15 years, T1D duration 25 ± 14 years) 42% used MDI + CGM, 40% CSII + CGM, 5% CSII + SMBG, and 13% MDI + SMBG. About 67% reported waking up ≥1 time in the past month due to NH symptoms. The most widely used strategies were verifying bedtime glycemia (71%), having an evening/bedtime snack (60%), and/or reducing nocturnal basal insulin (30%). PWT1D using CSII + CGM or CSII + SMBG relied more on basal insulin reduction (36% and 33.3%, respectively) compared to those using MDI + CGM (26%) or MDI + SMBG (19%). Less PWT1D using CSII + CGM reported having a snack to prevent NH (51%), compared to CSII + SBMG (61%), MDI + CGM (66%), and MDI + SBGM (67%) groups (p<0.001). Conclusion: Results suggest that PWT1D using technology choose different strategies to avoid NH than non-users. CSII users relying on basal insulin adjustment was expected as CSII offers more flexibility for insulin delivery. Snacks remain a popular strategy to prevent NH but are less used by PWT1D on CSII + CGM. While our findings provide some real-life insight into the methods PWT1D use to avoid NH, the efficacy of these strategies still needs further investigation. Disclosure M. K. Talbo: None. V. Messier: Other Relationship; Self; Eli Lilly and Company. K. Desjardins: None. R. Rabasa-lhoret: Advisory Panel; Self; Bayer Inc., Covance Inc., Insulet Corporation, Pfizer Inc., Other Relationship; Self; Abbott, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Dexcom, Inc., Eli Lilly and Company, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novo Nordisk, Sanofi-Aventis, Research Support; Self; Canadian Institutes of Health Research, Cystic Fibrosis Canada, Diabetes Canada, JDRF, National Institutes of Health, Prometic, Société Francophone du Diabète, Speaker’s Bureau; Self; CMS Canadian Medical&Surgical Knowledge Translation Research Group, CPD Network. A. Brazeau: None. T. Peters: None. Funding Canadian Institutes of Health Research (JT1-157204); JDRF (4-SRA-2018-651-Q-R)