OBJECTIVES: To describe the impact of severe hypoglycemic events (SHEs) and impaired awareness of hypoglycemia (IAH) on life and work productivity in adult continuous glucose monitor (CGM) users with type 1 diabetes (T1D), with a stratification across different insulin delivery methods.

METHODS: Participants (≥18 years) completed an online survey on the Diabetes Productivity Measure (DPM) and measures of SHE frequency and IAH status (modified Gold score ≤2 = normal awareness (IAH-); 3 = borderline (undetermined); ≥4 = impaired awareness (IAH+)). The DPM has two domains that measure life and work productivity impairment (score 0-100; higher score indicates greater productivity). Cohorts were created based on SHE frequency in the past year and IAH status: 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 insulin-delivery methods: multiple daily injections (MDI), predictive low glucose suspend (PLGS), hybrid closed-loop system/do-it-yourself (HCLS/DIY), and pump without automated insulin-delivery (pump no-AID). Work productivity was calculated for participants who reported being employed.

RESULTS: Total mean DPM scores for the Problematic SHEs cohort(n=219) were 62.6(SD=18.7[n=38]), 64.2(SD=17.0[n=22]), 67.3(SD=17.2[n=136]) and 73.2(SD=17.5[n=23]) v. No-SHE cohort(n=735) reported 75.5(SD=17.5[n=97]), 79.0(SD=16.1[n=36]), 78.8(SD=14.4[n=526]) and 75.8(SD=15.9[n=76]) for MDI, PLGS, HCLS/DIY and pump-no-AID, respectively. Mean life productivity for the Problematic SHEs cohort(n=375) was 58.6(SD=21.3[n=81]), 57.1(SD=21.3[n=33]), 58.9(SD=20.6[n=209]) and 61.1(SD=23.2[n=52]) v. No-SHE cohort(n=1,033), 71.7(SD=19.7[n=146]), 73.6(SD=18.3[n=55]), 72.8(SD=17.1 [n=713]) and 69.0(SD=18.7[n=119]) for MDI, PLGS, HCLS/DIY and pump-no-AID, respectively. Mean work productivity for the Problematic SHEs cohort(n=219) was 72.1(SD=19.2[n=38]), 73.0(SD=18.6[n=22]), 76.1(SD=16.3[n=136]) and 80.9(SD=14.0 [n=23]) v. No-SHE cohort(n=735), 84.6(SD=15.9[n=97]), 85.8(SD=15.8[n=36]), 86.6(SD=13.1[n=526]) and 82.6(SD=15.0[n=76]) for MDI, PLGS, HCLS/DIY and pump-no-AID, respectively.

CONCLUSIONS: Participants with Problematic SHEs reported greater life and work productivity impairment than those without SHEs, across different insulin-delivery methods.