Correlates of Hypoglycemia among Youth with Type 1 Diabetes (T1D) and Suboptimal Glycemic Control

Abstract

Hypoglycemia is a major challenge of T1D. We examined the prevalence and correlates of hypoglycemia assessed by 7-day blinded continuous glucose monitoring at baseline among 233 youth with hemoglobin A1c (HbA1c) of 8-13% per inclusion criteria in the Flexible Lifestyles Empowering Change trial. The sample was 76.1% non-Hispanic white and 49.8% female with mean age 14.9±1.1 years and mean T1D duration 6.4±3.7 years. Mean HbA1c was 9.6±1.2%. Over 7-days, 85.4% of youth experienced hypoglycemia (i.e., time ≤70 mg/dL and >54 mg/dL; an average of 32.5±37.3 min/day). 62.7% of youth experienced clinically serious hypoglycemia (i.e., time ≤54 mg/dL; an average of 24.5±40.5 min/day). Duration of hypoglycemia was inversely associated with HbA1c (Figure). In logistic regression modeling, sex, race/ethnicity, T1D duration, body mass index z-score (BMIz), fear of hypoglycemia (from the Hypoglycemia Fear Survey) and diabetes adherence (from the Diabetes Self-Management Profile-Self Report) were not associated with hypoglycemia. Youth with higher HbA1c were less likely to experience hypoglycemia (for a 1% higher HbA1c, odds ratio (OR) for clinical hypoglycemia: 0.52, (95% CI 0.39, 0.69); OR for clinically serious hypoglycemia: 0.58 (95% CI 0.43, 0.77)). The data suggest that hypoglycemia is common among youth with elevated HbA1c and and guidance to limit hypoglycemia should be part of care in these patients. Disclosure A.R. Kahkoska: None. J. Crandell: None. K.A. Driscoll: None. M.R. Kosorok: None. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions. E.J. Mayer-Davis: None.