Efficacy of treatment of non-severe hypoglycemia in adults with type 1 diabetes using oral carbohydrates during automated insulin delivery with and without glucagon

Objectives: Self-management guidelines for nonsevere hypoglycemia (NS-H) in type 1 diabetes recommend 15 g of simple carbohydrates (CHO) at 15-minute intervals. Because automated insulin delivery (AID) preventively reduces or suspends insulin infusion for imminent hypoglycemia, we aimed to determine whether guidelines were excessive during AID.Methods: This work was a secondary analysis of NS-H episodes during inpatient single-hormone (insulin) or dual-hormone (insulin and glucagon) AID trials with standardized CHO treatment protocols.Results: Forty NS-H episodes occurred: 15 during single-hormone arms (2 trials) and 25 during dual hormone arms (5 trials). At NS-H treatment T0min, plasma glucose (PG) level was 3.1 & PLUSMN;0.6 mmol/L, corresponding to a sensor value of 3.6 & PLUSMN;0.6 mmol/L. Fifteen minutes after CHO consumption, PG increased by 0.9 & PLUSMN;0.8 mmol/L, recovering 45% of episodes to a safe PG of >4.0 mmol/L. With repeated CHO consumption, time to recovery was 21.4 & PLUSMN;15.7 minutes without rebound hyperglycemia; PG 1 hour after initial CHO was 5.9 & PLUSMN;2.0 mmol/L. Outcome differences between single-hormone and dual-hormone systems were not statistically significant, except for higher insulin and glucagon levels and less repeated treatments in dual-hormone AID. PG and glucagon levels at T0min were positively associated with increase in PG at T15min and negatively associated with time to recovery.Conclusions: NS-H self-management CHO 15-g/15-minute guidelines were neither excessive nor optimal during AID. There is a need to examine data with different AID systems to optimize treatment recommendations.& COPY; 2023 Canadian Diabetes Association.