1037-OR: Neighborhood Affluence and Disadvantage Are Associated with Level 3 Hypoglycemia (Lv3 Hypo) in Adults with Type 1 Diabetes (T1D) Regardless of Diabetes Technology Use

Introduction and Objective: Prior research on Lv3 Hypo (i.e., requiring assistance) has emphasized individual-level risk factors, with limited evidence on the role of neighborhood socioeconomic context in adults with T1D, particularly in the era of advanced diabetes technologies. We analyzed U.S. survey data to address this gap. Methods: An online cross-sectional survey captured geographic sociodemographic and clinical data, including past-6-month Lv3 Hypo frequency, from adults (≥18 years) with T1D recruited nationally via T1D Exchange. Complete-case hurdle regression modeled associations between neighborhood affluence and disadvantage and Lv3 Hypo, adjusting for technology use (CGM or HCL) and individual-level factors (e.g., income and education). Technology use was also specified as an interaction term. Results: Among 1,402 respondents (mean [SD] age 45.5 [15.3] years; diabetes duration 27.1 [14.5] years), the mean [SD] number of Lv3 Hypo episodes was 1.71 [7.77]. Technology use included CGM alone (26%), CGM with HCL (69%), and no technology (5%). In adjusted analyses, higher neighborhood affluence and lower neighborhood disadvantage were associated with lower odds and rates of Lv3 Hypo, with no evidence of effect modification by technology use (Figure). Conclusion: Despite the use of diabetes technologies, neighborhood socioeconomic context is associated with Lv3 Hypo risk in adults with T1D. Disclosure M. Sinkewicz: None. A. Ratzki-Leewing: Advisory Panel; Current; Sanofi. Consultant; Current; Vertex Pharmaceuticals Incorporated, Dexcom, Inc. Research Support; Current; Sanofi. Other - Paid presentation; Ended; Abbott. Consultant; Current; Sanofi. Y. Lin: Other - Clinical trial site; Current; DEKA, Zucara Therapeutics.