# Hypoglycemia Awareness Trajectories in Young People with Type 1 Diabetes Using Flash Glucose Monitoring

## TL;DR

This study tracks how young people with Type 1 diabetes experience changes in their awareness of low blood sugar over two years using flash glucose monitoring.

## Contribution

The study identifies distinct trajectories of hypoglycemia awareness in children and adolescents with Type 1 diabetes over time.

## Key findings

- Four distinct hypoglycemia awareness trajectories were identified among 255 participants.
- Participants who developed impaired awareness of hypoglycemia were younger on average.
- Frequent assessments of hypoglycemia awareness may improve risk management in young children with Type 1 diabetes.

## Abstract

The trajectories of the hypoglycemia awareness status (HAS) have not yet been studied in children and adolescents with Type 1 diabetes (T1D).

This 2-year follow-up study included children and adolescents with T1D aged 6‒20 years old and using flash glucose monitoring. The HAS of each participant was determined by the Gold score and assessed at three time points, along with clinical data. The trajectories based on HAS progression over time were identified, and a logistic regression analysis was performed to compare their characteristics.

Among the 255 participants, we identified four HAS trajectories (T1–T4). T1: normal awareness of hypoglycemia (NAH) maintained over time (n = 82, 29%); T2: NAH recovered during follow-up (n = 40, 18%); T3: impaired awareness of hypoglycemia (IAH) developed during follow-up (n = 28, 12.4%); T4: IAH maintained over time (n = 59, 21%). Sixteen participants (7%) displayed no identifiable trajectory. Participants belonging to the T3 group were younger. Following a specific trajectory defined the risk of developing future severe hypoglycemia.

HAS changed in a significant proportion of pediatric people with T1D over time. Participants with a trajectory toward IAH were younger. Frequent HAS assessments may help to improve hypoglycemia risk management, especially in young children with T1D.