7-LB: Gender Differences in Reported Consequences of Level 2 and Level 3 Hypoglycemia among Adults Living with Type 1 Diabetes—A BETTER Registry Analysis
Authors: TALBO MERYEM K. , LEBBAR MAHA , MESSIER VIRGINIE , WU ZEKAI , BRAZEAU ANNE-SOPHIE , RABASA-LHORET RÉMI 
Published: May 2022

Introduction: Hypoglycemia is a common side effect of type 1 diabetes (T1D) therapy with consequences ranging from physical and cognitive impairment to reduced quality of life. Studies evaluating consequences of level 2 (L2H, glucose level&lt;3.0mmol/L without needing assistance from another person to recover) and level 3 (L3H, needing assistance from another person) hypoglycemia between the genders are sparse.
Aim: To highlight the differences in reported consequences related to both L2H and L3H between genders.
Methods: Self-reported data from an online Canadian registry of adults with T1D were analyzed using logistic regression models adjusted for age, diabetes technology use, hypoglycemia history in the past month, Hypoglycemia Fear Survey II (HFS II) , and Hypoglycemia Confidence Scale (HCS) scores.
Results: Among 877 adults (65% women, mean age 43 ± 15 years, mean duration of T1D 25 ± 15 years, 34% reported a HbA1c ≤ 7.0%, 81% used continuous glucose monitoring, and 43% used an insulin pump) , 15% experienced L3H in the past year and 81% experienced L2H in the past month. Women reported more L2H (84% vs. 75%, p=0.004) and worse HFS-II and HCS scores than men (median 33 [IQR 23, 47] vs. 28 [18, 38], p=0.002 and 3.2 [2.9, 3.6] vs. 3.4 [3.0, 3.8], p&lt;0.001, respectively) . The adjusted regression models showed that women were more likely than men to report experiencing persistent fatigue after L2H (OR 1.76, 95%CI [1.19, 2.61]) and increased anxiety, persistent fatigue, or an additional encounter with a healthcare professional after a L3H episode (1.71 [1.04, 2.82]; 1.75 [1.02, 3.00]; 2.59 [1.17, 5.74], respectively) .
Conclusion: Women report significantly more L2H and L3H consequences compared to men, in addition to reporting higher fear and lower confidence. Social constructs on stress management may explain the observed gender differences, and suggest taking a gender-based differential approach when addressing hypoglycemia.

Disclosure
M. K. Talbo: None. M. Lebbar: None. V. Messier: None. Z. Wu: Other Relationship; Eli Lilly and Company. A. Brazeau: Research Support; Eli Lilly and Company, Novo Nordisk, Sanofi. R. Rabasa-lhoret: Consultant; HLS Therapeutics Inc., Pfizer Inc., Other Relationship; Abbott Diabetes, AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novo Nordisk Canada Inc., Sanofi, Vertex Pharmaceuticals Incorporated, Research Support; Canadian Institutes of Health Research, Cystic Fibrosis Canada, Diabetes Canada, Fondation Francophone pour la Recherche en Diabète (FFRD) , JDRF, National Institutes of Health, Société Francophone du Diabète (SFD) , Speaker’s Bureau; Canadian Medical & Surgical Knowledge Translation Research Group (CMS) , CPD Network, Tandem Diabetes Care, Inc.

Funding
Canadian Institutes of Health Research (JT1-157204) and Juvenile Diabetes Research Foundation (4-SRA-2018-651-Q-R)