2944-LB: Duration–Severity Discordance in Pediatric Hypoglycemia: A Novel Risk Stratification Framework Using Episode-Level CGM Analytics in Young Adults with Type 1 Diabetes

Introduction and Objective: Current CGM guidelines use time below range (TBR<70mg/dL, target<4%) as the primary hypoglycemia metric. Identical TBR values may represent frequent brief episodes or rare prolonged events with vastly different safety implications. We investigated whether mean hypoglycemic episode duration provides complementary risk information in pediatric/young adult type 1 diabetes. Methods: Retrospective analysis of CGM data from 20 T1D patients (55% female; median age 20y, range 11-25; median diabetes duration 8y) at a tertiary center in North India (2024). A hypoglycemic event was defined as consecutive readings <70mg/dL for ≥15 minutes. Primary endpoint: mean hypoglycemic episode duration per patient. Secondary: age-stratified duration analysis (11-15, 16-18, 19-21, 22-25y) and duration-based phenotype classification. Results: Median TIR was 41% (5-97%), TBR 4% (0-9%), CV 38% (25-60%). Sixteen patients (80%) had hypoglycemic events. Mean episode duration ranged from 50-236 minutes (median 93min)—a 4.7-fold variation. Three phenotypes emerged: Rapid Responders (37.5%; 50-72min), Delayed Responders (50%; 93-131min), and Critical Non-Responders (12.5%; >180min). Critically, one patient with TBR 8% (borderline) had mean duration of 236 minutes (3.9 hours), indicating severe acute risk masked by percentage metrics. Age analysis revealed peak vulnerability at 19-21 years (median 120min) versus 11-15y (72min), 16-18y (93min), and 22-25y (77min), coinciding with transition to independent living. Conclusion: Mean hypoglycemic episode duration identifies high-risk patients invisible to TBR alone. We propose a 120-minute threshold triggering urgent intervention regardless of TBR. Episode-level duration analytics should be incorporated into routine CGM reporting alongside TIR and TBR to enable dual-axis hypoglycemia risk stratification, particularly for transition-age young adults. Disclosure A. Maheshwari: None. S. Singla: None. S. Patil: None. A. Tewari: None. N. Verma: None.