What question did this study set out to answer?

This study aims to investigate how glycemia, sleep, and physical activity affect hypoglycemic awareness and counterregulation in type 1 diabetes.

June 7, 2026

1350-P: Impact of Glycemia, Sleep, Physical Activity on Hypoglycemia Counterregulation in Type 1 Diabetes

Key Points

This study aims to investigate how glycemia, sleep, and physical activity affect hypoglycemic awareness and counterregulation in type 1 diabetes.
Two studies pooled data from 60 T1D participants, using CGM and actigraphy for one week prior to hyperinsulinemic clamps.
Participants underwent 3-4 clamps with target glucose levels set at 50 mg/dL.
Associations between epinephrine responses and previous week’s CGM and activity data were assessed using R, adjusting for multiple tests.
Average epinephrine levels measured were 204±21 pg/ml during the first clamp, with symptom scores averaging 24±1.
CGM-derived variables showed significant associations with epinephrine responses, particularly stronger at the last clamp.
Increased days of moderate-vigorous physical activity were linked to reduced adrenergic symptoms after recurrent hypoglycemia.

Abstract

Introduction and Objective: How glucose variability, sleep, physical activity modify risk of impaired awareness of hypoglycemia in T1D is unclear. We investigated associations between prior week CGM and actigraphy with epinephrine and symptom responses to recurrent hypoglycemia (HG) in aware participants with T1D. Methods: Data were pooled from 2 studies (N=60 T1D, 15 participated in both; age 29 ± 8 yrs, 37 female, A1c 7 ± 1, duration 16 ± 7 yrs, HbA1c 8.5, aware on the Clarke 54mg/l were associated with epinephrine at both clamps, with stronger associations at LC (Fig. 1). Daily MVPA was associated with adrenergic symptoms at LC. No other associations were observed. Conclusion: HG exposure experienced within 1 week of a HG clamp study is associated with reduced counterregulation in aware T1D. HG responses are further reduced with repeated HG exposure. Prior week moderate-vigorous activity lowers adrenergic symptoms after recurrent HG. Disclosure E. Seaquist: Advisory Panel; Current; Vertex Pharmaceuticals Incorporated, Zucara Therapeutics. A. Kumar: None. L. Zhang: None. B. Strong: None. L. Eberly: None. A. Moheet: None. G. Oz: Research Support; Ended; Biogen. Consultant; Current; Servier Laboratories. Advisory Panel; Current; BrainSpec. Funding R01 NS035192 (ERS, GÖ), NIH P41 EB027061, P30 NS076408, S10OD017974 from the National Institutes of Health.

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