1358-P: Regional Variation in Severe Hypoglycemia and Its Association with Diabetologist Density among Older Adults in Japan

Introduction and Objective: Severe hypoglycemia in older adults is a major safety concern. We quantified prefecture-level variation in severe hypoglycemia in Japan and examined its association with diabetologist density. Methods: Ecological cross-sectional study of 47 prefectures. We used prehospital glucose administrations per 100,000 population among adults ≥65 years in 2022 EMS statistics as a proxy for severe hypoglycemia. Diabetologist density was certified diabetologists per 100,000 population. Prefecture-level glucose-lowering prescriptions, including insulin proportion, were obtained from the Musubi database (2019-2025). Pearson correlations were calculated between diabetologist density, hypoglycemia incidence, and insulin use. Results: Incidence varied by up to tenfold across prefectures. Diabetologist density was inversely correlated with hypoglycemia incidence (r = −0.331, P < 0.05) and positively correlated with the proportion of insulin prescriptions (r = 0.323, P < 0.05). Conclusion: Severe hypoglycemia requiring prehospital glucose administration showed geographic disparities and was inversely associated with diabetologist density. Prefectures with more diabetologists also had higher insulin use, suggesting that specialist involvement may improve the safety of glucose-lowering therapy. Disclosure M. Sakamoto: Speaker's Bureau; Current; Eli Lilly and Company, Novo Nordisk, Tanabe Pharma Corporation, Boehringer Ingelheim Seiyaku Co., Ltd., MSD K.K., Daiichi Sankyo, Sumitomo Pharma Co., Ltd. Consultant; Current; KAKEHSHI Inc. T. Saika: None. Y. Kado: None. T. Takebe: Employee; Current; KAKEHASHI Inc. M. Yamazaki: None.