162-OR: Effect of Automated Insulin Delivery on Glucose Counterregulation in Long-Standing Type 1 Diabetes

Automated insulin delivery (AID) systems are likely of value in individuals with long-standing T1D where recurrent hypoglycemia reduces counterregulatory response. This study assessed the impact of 18M AID on counterregulatory response to insulin-induced hypoglycemia in individuals with long-standing T1D and impaired awareness of hypoglycemia. participants mean±SD age 49±16 years and diabetes duration 34±16 years were initiated on AID systems. CGM outcomes were paired with actigraphy data to assess daytime and sleep hypoglycemia exposure every 3 months. Hyperinsulinemic stepped-hypoglycemic clamp experiments were performed at baseline, 6 and 18 months. Ten and nine participants have been followed-up to 6M and 18M respectively. Severe hypoglycemia events were reduced from median (IQR) 3 (3-10) to 0 (0-1) events/person·year over 18M (p=0.005) with improved hypoglycemia severity (HYPO, Pre:1134 (808-1686) to 18M:26 (0-128) , p