4-OR: Impaired Awareness of Hypoglycemia (IAH) in Older Adults with Type 1 Diabetes in the WISDM Study

Abstract

Background: The prevalence of IAH in type 1 diabetes (T1D) varies from 20 - 37%. Risk factors for IAH include advanced age, longer diabetes duration, recurrent hypoglycemic events, and high glucose variability. Little is known about IAH in older adults with T1D. Methods: Participants with T1D and ≥60 years of age enrolled in the WISDM study were defined as having IAH if their Clarke score was ≥ 4 or normal awareness (NAH) if <4. We compared continuous glucose monitoring (CGM) metrics in those with IAH and NAH at baseline and in those in whom IAH did or did not improve over 26 weeks of observation. Results: Of the 199 participants (mean age 68 years, 52% females, 96% White), 61 (30.6%) had IAH. Daytime hypoglycemia was more common in those with compared to those without IAH at baseline (Table). After 26 weeks, daytime hypoglycemia and glycemic variability were significantly less in those in whom IAH improved (n=18) compared to those in whom it did not (n=40). Conclusion: Results of this analysis in older adults with T1D confirm that diabetes duration, c-peptide and %CV are associated with IAH. Among those with IAH, daytime hypoglycemia was significantly more common, while improvements in IAH over 26 weeks were associated with significantly lower rates of daytime hypoglycemia at follow up. Disclosure A.Bilal: None. F.Yi: None. K.J.Whitaker: None. R.E.Pratley: Other Relationship; Bayer Inc., Corcept Therapeutics, Dexcom, Inc., Gasherbrum Bio, Inc., Hanmi Pharm. Co., Ltd., Hengrui (USA) Ltd., Merck Sharp & Dohme Corp., Novo Nordisk, Pfizer Inc., Rivus Pharmaceuticals Inc., Sanofi, Scohia Pharma Inc., Sun Pharmaceutical Industries Ltd. A.Casu: None.