Despite advances in diabetes technology, severe hypoglycemia events (SHE) remain a persistent concern for people with type 1 diabetes. A study published in Diabetologia assessed whether continuous glucose monitoring metrics, specifically time below range (TBR), combined with hypoglycemia awareness status, could improve prediction of SHE risk.

The analysis included 848 adults with type 1 diabetes from the Study of the French-speaking Society of Type 1 Diabetes (SFDT1) cohort, with a mean age of 41.6 years, 53.8% women, and mean HbA1c of 7.4%. During one year of follow-up, the incidence of SHE was 11.7%. When stratified by TBR at 3.9 mmol/L (70 mg/dL, TBR70), event rates were 12.1% for ≤1%, 10.2% for 1.1–3.9%, 10.6% for 4–6%, and 14.6% for >6%. For TBR at 3.0 mmol/L (54 mg/dL, TBR54), incidence was 11.0% for <1% and 13.3% for ≥1%.

Crucially, elevated risk emerged only in participants with impaired awareness of hypoglycemia (IAH). Those with TBR70 >6% and IAH had over threefold increased risk of SHE (OR 3.32; 95% CI 1.40–7.82). Similarly, TBR54 ≥1% with IAH conferred higher risk (OR 2.99; 95% CI 1.46–5.92). Spline analyses confirmed that risk patterns were non-linear and confined to the IAH subgroup.

These findings highlight that TBR alone is insufficient to identify high-risk individuals, but when combined with hypoglycemia awareness status, it can guide targeted interventions and personalized care.