Endocrine Abstracts

The use of continuous glucose monitoring (CGM) by individuals with type 1 diabetes (T1D) has revolutionized the management of hypoglycemia. Previously, hypoglycemia was defined solely by a glucose threshold. However, CGM has introduced the additional dimension of time. International consensus guidelines now define CGM-detected hypoglycemia as glucose levels below the hypoglycemic threshold for at least 15 minutes. Using this definition, a high proportion (>60%) of hypoglycemic episodes are asymptomatic, and over a third of symptomatic episodes occur at glucose levels above 3.9 mmol/l. The significance of these asymptomatic episodes remains unclear. The Hypo-METRICS study, a multinational, multicenter study conducted as part of the HypoRESOLVE consortium, explored the biopsychosocial impact of both symptomatic and asymptomatic hypoglycemia. Participants wore a blinded CGM for 10 weeks and recorded their hypoglycemia experiences in real time using a smartphone app. Data from Hypo-METRICS revealed that while asymptomatic hypoglycemia had no impact on daily functioning, any episode identified as hypoglycemia by individuals with T1D, regardless of glucose level, negatively impacted daily functioning. Additionally, the study showed that time below range as a metric correlates poorly with the lived experience of hypoglycemia. These findings have significant implications for clinical and research practices. They highlight the importance of reporting the lived experience of hypoglycemia, even in the age of CGM and its hypoglycemia metrics.