OBJECTIVE To determine how diabetes technologies, including continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems, impact glycemic metrics, prevalence of severe hypoglycemic events (SHEs), and impaired awareness of hypoglycemia (IAH) in people with type 1 diabetes in a real-world setting within the U.S. RESEARCH DESIGN AND METHODS In this retrospective, observational study with cross-sectional elements, participants aged ≥18 years were enrolled from the T1D Exchange Registry/online community. Participants completed a one-time online survey describing glycemic metrics, SHEs, and IAH. The primary objective was to determine the proportions of participants who reported achieving glycemic targets (assessed according to self-reported hemoglobin A1c) and had SHEs and/or IAH. We performed additional subgroup analyses focusing on the impact of CGM and insulin delivery modality. RESULTS A total of 2,074 individuals with type 1 diabetes were enrolled (mean ± SD age 43.0 ± 15.6 years and duration of type 1 diabetes 26.3 ± 15.3 years). The majority of participants (91.7%) were using CGM, with one-half (50.8%) incorporating AID. Despite high use of diabetes technologies, only 57.7% reported achieving glycemic targets (hemoglobin A1c <7%). SHEs and IAH still occurred, with ∼20% of respondents experiencing at least one SHE within the prior 12 months and 30.7% (95% CI 28.7, 32.7) reporting IAH, regardless of CGM or AID use. CONCLUSIONS Despite use of advanced diabetes technologies, a high proportion of people with type 1 diabetes do not achieve glycemic targets and continue to experience SHEs and IAH, suggesting an ongoing need for improved treatment strategies.

中文翻译：

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尽管使用糖尿病技术，1 型糖尿病患者仍然存在严重低血糖和低血糖意识受损：横断面调查结果

目的 确定糖尿病技术（包括连续血糖监测 (CGM) 和自动胰岛素输送 (AID) 系统）如何影响 1 型糖尿病患者的血糖指标、严重低血糖事件 (SHE) 的患病率以及低血糖意识受损 (IAH)在美国的现实环境中 研究设计和方法 在这项具有横断面要素的回顾性观察性研究中，年龄≥18 岁的参与者是从 T1D 交换登记处/在线社区招募的。参与者完成了一项一次性在线调查，描述血糖指标、SHE 和 IAH。主要目标是确定报告达到血糖目标（根据自我报告的糖化血红蛋白评估）并患有 SHE 和/或 IAH 的参与者比例。我们进行了额外的亚组分析，重点关注 CGM 和胰岛素输送方式的影响。结果 共有 2,074 名 1 型糖尿病患者入组（平均 ± 标准差，年龄 43.0 ± 15.6 岁，1 型糖尿病病程 26.3 ± 15.3 年）。大多数参与者 (91.7%) 使用 CGM，其中一半 (50.8%) 结合了 AID。尽管糖尿病技术的使用率很高，但只有 57.7% 的人报告实现了血糖目标（血红蛋白 A1c <7%）。 SHE 和 IAH 仍然发生，约 20% 的受访者在过去 12 个月内至少经历过一次 SHE，30.7% (95% CI 28.7, 32.7) 报告发生了 IAH，无论是否使用 CGM 或 AID。结论 尽管使用了先进的糖尿病技术，但仍有很大一部分 1 型糖尿病患者未达到血糖目标，并继续经历 SHE 和 IAH，这表明持续需要改进的治疗策略。