Frequency of rebound hyperglycemia in adults with type 1 diabetes treated with different insulin delivery modalities.

Abstract

For people with type 1 diabetes, ensuring fast and effective recovery from hypoglycemia while avoiding post-hypoglycemic hyperglycemia (rebound hyperglycemia, RH) can be challenging. The objective of this study was to investigate the frequency of RH across different treatment modalities and its impact on glycemic control. This cross-sectional real-world study included adults with type 1 diabetes using CGM and attending the outpatient clinic at Steno Diabetes Center Copenhagen. RH was defined as ≥1 sensor glucose value (SG) >10.0 mmol/l (180 mg/dL) starting within two hours of an antecedent SG < 3.9 mmol/l (70 mg/dL). The severity of the RH events was calculated as area under the curve (AUC) and separately for users of multiple daily injections (MDI), unintegrated insulin pumps, sensor augmented pumps (SAP) and automated insulin delivery (AID), respectively. Across the four groups, SAP and AID users had the highest incidence of RH (2.1 ± 1.65 and 2.08 ± 1.49 events pr week, respectively) and a similar percentage of hypoglycemic events leading to RH events (41.3 ± 22.8% and 39.6 ± 20.1%, respectively). The AID users RH events were significantly shorter compared to MDI users (122 ± 72 vs. 185 ± 135 minutes; p< 0.0001). Overall, severity of RH was inversely associated with more advanced technology (p< 0.001) and inversely associated (p<0.001) with time in target glucose range (TIR). Groups with insulin suspension features experienced the highest frequency of RH, however AID users tended to experience shorter and less severe RH events. The association between the severity of RH events and TIR suggests that RH should be assessed and used in guidance of hypoglycemia management.