OBJECTIVES: To describe the impact of severe hypoglycemic events (SHEs) and impaired awareness of hypoglycemia (IAH) on sleep quality in adult continuous glucose monitor (CGM) users with type 1 diabetes (T1D).

METHODS: Participants (≥18 years old) completed an online survey on measures of SHE frequency, IAH status and an item on sleep quality (higher score=better sleep quality). Cohorts were created based on SHE frequency in the past year and IAH status (modified Gold score ≤2=normal awareness (IAH-); 3=borderline (undetermined); ≥4=impaired awareness (IAH+)): Problematic SHEs (2+ SHEs/IAH-; 1+ SHE/IAH+), Single SHE/no-IAH (1 SHE/IAH-), Undetermined IAH (≥0 SHE/borderline IAH), and No-SHE (0 SHE/IAH+; 0 SHE/IAH-). Results were stratified by diabetes technology subtypes: predictive low glucose suspend (PLGS), multiple daily injections (MDI), hybrid closed-loop system/do-it-yourself (HCLS/DIY), and pump without automated insulin delivery (pump-no-AID). Descriptive results (mean, standard deviation [SD], counts, percentages) of participant characteristics and survey responses were reported.

RESULTS: Participants (N=1,847), including Problematic SHEs (n=375), Single SHE/no-IAH (n=102), Undetermined IAH (n=337) and No-SHE (n=1,033) cohorts completed the survey. Overall, mean age was 45.9 years (SD=15.3) and duration of T1D diagnosis was 29.0 years (SD=15.1). In addition to other clinical characteristics reported, more participants in the Problematic SHEs cohort (28.8%) self-reported ‘sleep disorder’ as a comorbid condition vs. 16.6% in the No-SHE cohort. Mean sleep quality score for the Problematic SHEs cohort was 4.8(SD=2.8), 5.4(SD=2.4), 5.7(SD=2.3) and 6.1(SD=2.3), whereas the No-SHE cohort reported 6.2(SD=2.1), 6.4(SD=2.1), 6.4(SD=2.0) and 6.0(SD=2.0) for PLGS, MDI, HCLS/DIY, pump-no-AID, respectively.

CONCLUSIONS: Except for pump-no-AID users, participants experiencing multiple SHEs and/or IAH generally reported lower sleep quality than those without SHEs across diabetes technology subtypes.