1350-P: Impact of Glycemia, Sleep, Physical Activity on Hypoglycemia Counterregulation in Type 1 Diabetes

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Introduction and Objective: How glucose variability, sleep, physical activity modify risk of impaired awareness of hypoglycemia in T1D is unclear. We investigated associations between prior week CGM and actigraphy with epinephrine and symptom responses to recurrent hypoglycemia (HG) in aware participants with T1D. Methods: Data were pooled from 2 studies (N=60 T1D, 15 participated in both; age 29 ± 8 yrs, 37 female, A1c 7 ± 1, duration 16 ± 7 yrs, HbA1c <8.5, aware on the Clarke & Gold questionnaires). Participants wore CGM and actigraphs the week before undergoing 3 (study 1) or 4 (study 2) hyperinsulinemic clamps over 2 days (target glucose=50mg/dL). Epinephrine and symptoms were collected during the final 30 min of first (FC) and last (LC) clamps and their associations with CGM and actigraphy assessed in R, adjusting for multiple testing. Results: Epinephrine was 204±21 pg/ml (range 47-836) and symptom score was 24±1 (range 4-46) in FC. CGM derived CV, ADRRlow, LBGI, and % readings <54mg/l were associated with epinephrine at both clamps, with stronger associations at LC (Fig. 1). Daily MVPA was associated with adrenergic symptoms at LC. No other associations were observed. Conclusion: HG exposure experienced within 1 week of a HG clamp study is associated with reduced counterregulation in aware T1D. HG responses are further reduced with repeated HG exposure. Prior week moderate-vigorous activity lowers adrenergic symptoms after recurrent HG. Disclosure E. Seaquist: Advisory Panel; Current; Vertex Pharmaceuticals Incorporated, Zucara Therapeutics. A. Kumar: None. L. Zhang: None. B. Strong: None. L. Eberly: None. A. Moheet: None. G. Oz: Research Support; Ended; Biogen. Consultant; Current; Servier Laboratories. Advisory Panel; Current; BrainSpec. Funding R01 NS035192 (ERS, GÖ), NIH P41 EB027061, P30 NS076408, S10OD017974 from the National Institutes of Health.

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