Severe hypoglycemia events (SHE) continue to pose a significant burden for adults with type 1 diabetes (T1D), even with modern continuous glucose monitoring (CGM) technologies. Findings presented at the European Association for the Study of Diabetes 2025 evaluated 848 SFDT1 participants who used CGM.

Impaired awareness of hypoglycemia (IAH) was assessed using the Gold Score, and participants self-reported SHE occurrence over a 12-month period. Logistic regression models adjusted for age, sex, social vulnerability, and insulin treatment were used to evaluate the relationship between time below range (TBR) and SHE. Spline analyses explored non-linear risk patterns.

Overall, 11.7% of participants experienced at least one SHE. Time below range alone (<70 mg/dL or <54 mg/dL) was not predictive of events. However, participants with both high TBR70 (>6%) and IAH had a threefold increased risk (OR 3.32, 95% CI 1.40–7.82). Similarly, TBR54 ≥1% combined with IAH also increased risk (OR 2.99, 95% CI 1.46–5.92).

These findings highlight that combining TBR metrics with hypoglycemia awareness status is essential to identify T1D patients at highest risk and guide personalized preventive strategies.