59-LB: The Impact of Glycemic Variability on the Relationship between Hypoglycemia and HbA1c

Introduction: Continuous glucose monitoring (CGM) guidelines suggest a target glycemic variability, as measured by coefficient of variation (CV) ≤36%, to mitigate hypoglycemia in people with type 1 diabetes (T1D). However, they provide no context to hemoglobin A1c (HbA1c) values. The aim of this study was to evaluate the relationship between CV, hypoglycemia, and HbA1c among adults with T1D. Methods: A retrospective sample of adults (≥18 years) with T1D from the Barbara Davis Center for Diabetes who had available ambulatory glucose profiles and laboratory-measured HbA1c were analyzed at the patient-visit level between 2014 and 2020. Negative binomial regression of aggregated data over 7 days was used to estimate the number of level-2 ( Results: Among 466 adults with T1D (mean age=37 years) at 1,648 visits, percentage of CGM use was 91%. We observed wide variation in level 2 hypoglycemic events across CV and HbA1c categories (Figure 1). The highest mean estimated number of events was 3.5 (95% CI: 2.4, 4.6) per week, found in patients with CV > 36%, HbA1c Conclusion: Glycemic variability (CV) provides meaningful insights about level 2 hypoglycemia that should be used in combination with HbA1c and other factors to inform clinical decision making to help mitigate risk for possible hypoglycemia. Disclosure R. Mcqueen: Research Support; Self; Eli Lilly and Company. S. Ellis: Research Support; Self; Eli Lilly and Company. M. Perez-nieves: Employee; Self; Eli Lilly and Company. G. T. Alonso: None. R. Juneja: Employee; Self; Eli Lilly and Company. K. Hannah: None. L. Fan: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company, Stock/Shareholder; Spouse/Partner; Eli Lilly and Company. E. R. Hankosky: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company. V. Shah: Advisory Panel; Self; Medscape, Sanofi, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Sanofi, vTv Therapeutics. Y. Yan: Employee; Self; Eli Lilly and Company. Funding Eli Lilly and Company