The Impact of Routine CGM on Hypoglycemia Rates and Psychological Outcomes in the Hypo-METRICS Study

We aimed to compare weekly rates of sensor detected hypoglycemia (SDH), person reported hypoglycemia (PRH) and psychological outcomes in people with type 1 (T1D) and insulin treated type 2 diabetes (T2D) using routine continuous glucose monitoring (CGM) or capillary blood glucose monitoring (BGM) in the prospective observational Hypo-METRICS study. Participants (T1D/CBG=67, T1D/CGM=210, T2D/CBG=192, T2D/CGM=133, 55% men, median (IQR) age 56 (45-66) years) completed person reported outcomes measures, wore a blinded study CGM and reported PRH in real time on the Hypo-METRICS app for 10 weeks. We used the Wilcoxon rank sum test. Median weekly PRH rates were higher in CGM vs BGM users in both T1D (4.5 (2.4-6.3) vs 2.6 (1-3.9) Z=-5.1, p<0.005) and T2D (1.7 (0.6-2.3) vs 1.0 (0.2-1.2), Z=-5.8 p<0.005). There were no differences in SDH rates at 70 or 54mg/dl for CGM or BGM users with T1D or T2D (Table 1). Diabetes distress (Problem Areas In Diabetes) was higher in CGM vs BGM users with T1D (25 (10-36) vs 19 (5-26), Z=-3.2, p=0.008), but not T2D. There were no significant differences between CGM and BGM users in Hypoglycaemia Fear Survey Behaviour or Worry subscales, depression (PHQ-9) or anxiety (GAD-7) in either group. Despite similar SDH rates, T1D CGM users have higher PRH and diabetes distress scores; this may reflect populations with greater access to CGM. Further research is needed to investigate these findings. Disclosure N.Zaremba: None. M.Evans: Advisory Panel; Zucara Therapeutics, Pila Pharma, Dexcom, Inc., Other Relationship; Novo Nordisk, AstraZeneca, Abbott Diabetes, Speaker's Bureau; Eli Lilly and Company. E.Renard: Consultant; Abbott Diabetes, Dexcom, Inc., AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Company, Insulet Corporation, MannKind Corporation, Novo Nordisk, Sanofi, Roche Diabetes Care. S.R.Heller: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Other Relationship; Eli Lilly and Company, Research Support; Dexcom, Inc., Speaker's Bureau; Novo Nordisk, Medtronic. J.Speight: Research Support; Sanofi, Medtronic, Abbott Diabetes, Lilly, Novo Nordisk A/S, Speaker's Bureau; Sanofi. S.A.Amiel: Advisory Panel; Medtronic, Other Relationship; Sanofi, Novo Nordisk. P.Choudhary: Advisory Panel; Medtronic, Novo Nordisk, Dexcom, Inc., MannKind Corporation, Insulet Corporation, Research Support; Abbott Diabetes, Speaker's Bureau; Sanofi, Lilly. P.Divilly: None. G.Martine-edith: Other Relationship; Novo Nordisk A/S. Z.Mahmoudi: Employee; Novo Nordisk. U.Soeholm: Employee; Novo Nordisk A/S. B.E.De galan: Research Support; Novo Nordisk. U.Pedersen-bjergaard: Advisory Panel; Novo Nordisk A/S, Sanofi, Vertex Pharmaceuticals Incorporated. R.J.Mccrimmon: Advisory Panel; Sanofi, Speaker's Bureau; Novo Nordisk A/S. J.K.Mader: Advisory Panel; Novo Nordisk A/S, Abbott Diabetes, Roche Diabetes Care, Eli Lilly and Company, Sanofi, Medtronic, Becton, Dickinson and Company, Pharmasense, embecta, Research Support; A. Menarini Diagnostics, Abbott Diabetes, Roche Diabetes Care, Dexcom, Inc., Profusa, Inc., Speaker's Bureau; Novo Nordisk A/S, A. Menarini Diagnostics, Abbott Diabetes, Roche Diabetes Care, Eli Lilly and Company, Sanofi, Boehringer Ingelheim Inc., Becton, Dickinson and Company, Ypsomed AG, Viatris Inc., Servier Laboratories, Medtrust, Stock/Shareholder; Decide Clinical Software GmbH. Funding Innovative Medicines Initiative 2 Joint Undertaking (777460)