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Time Below Range and Its Influence on Hypoglycemia Awareness and Severe Hypoglycemia: Insights From the Association of British Clinical Diabetologists Study

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posted on 2025-04-11, 09:08 authored by Harshal Deshmukh, Emma G Wilmot, Pratik ChoudharyPratik Choudhary, Emmanuel Ssemmondo, Dennis Barnes, Neil Walker, Chris Walton, Robert EJ Ryder, Thozhukat Sathyapalan
OBJECTIVE This study aimed to explore the relationship between time below range (TBR), impaired awareness of hypoglycemia (IAH), and severe hypoglycemia (SH). RESEARCH DESIGN AND METHODS This cross-sectional study analyzed data from individuals with diabetes using continuous glucose monitors (CGMs) in the Association of British Clinical Diabetologists audit. Hypoglycemia awareness was assessed via the Gold score (≥4 denoting IAH), and SH was defined as hypoglycemia requiring third-party assistance. Logistic regression was used to determine the association between TBR percentage (<70 mg/dL; 3.9 mmol/L) at first follow-up and follow-up Gold score and SH incidence. The Youden J index identified optimal TBR percentage cutoffs for detecting IAH and SH. RESULTS The study included 15,777 participants, with follow-up TBR and SH data available for 5,029. The median TBR percentage was 4% (interquartile range 2–6.6%), with 42% meeting the recommended TBR of ≤4%. Adjusted for age, sex, and BMI, TBR was significantly associated with SH (P < 0.001) and IAH (P = 0.005). Optimal TBR cutoffs for identifying IAH and SH were 3.35% and 3.95%, yielding negative predictive value (NPV) values of 85% and 97%, respectively. CONCLUSIONS Our findings support the international consensus recommending a TBR of <4% in type 1 diabetes, with high NPV values suggesting the utility of TBR in screening for SH.

History

Author affiliation

College of Life Sciences Population Health Sciences

Version

  • AM (Accepted Manuscript)

Published in

Diabetes Care

Volume

48

Issue

3

Pagination

437 - 443

Publisher

American Diabetes Association

issn

0149-5992

eissn

1935-5548

Copyright date

2025

Available date

2025-04-11

Spatial coverage

United States

Language

en

Deposited by

Professor Pratik Choudhary

Deposit date

2025-03-26

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