{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T13:40:50Z","timestamp":1777556450495,"version":"3.51.4"},"reference-count":41,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Technology &amp; Therapeutics"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite advances in diabetes technologies, severe hypoglycemia (SH) and level 2 hypoglycemia (Lv2Hypo) persist among hybrid closed-loop (HCL) insulin pump users. This study assessed the relationship of impaired awareness of hypoglycemia (IAH) and other patient characteristics with SH and Lv2Hypo in HCL insulin pump users with type 1 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A cross-sectional survey assessed 6-month SH history, hemoglobin A1C, IAH (using the Hypoglycemia Awareness Questionnaire), and 30-day continuous glucose monitoring (CGM) data among adult HCL insulin pump users recruited from a national U.S. type 1 diabetes patient registry. Analyses included logistic regression,\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -tests, and Chi-square tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 601 participants (female: 54%; mean age: 43), IAH and higher glucose coefficients of variation (CVs) were associated with both SH and spending \u22651% of time in Lv2Hypo (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      s &lt; 0.05). Individuals with SH were further characterized as having spent more time with glucose levels &gt;180 mg\/dL and &gt;250 mg\/dL and having a lower education level (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      s &lt; 0.05). CGM hypoglycemia measures were not associated with SH. Age and diabetes duration were not associated with experiencing SH or spending \u22651% of time in Lv2Hypo. Participants who both experienced SH and spent \u22651% of time in Lv2Hypo showed trends toward exhibiting the most severe IAH and the highest glucose CVs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Among adults with type 1 diabetes using HCL insulin pumps, IAH and higher glucose CVs are risk factors of experiencing SH and Lv2Hypo. Hyperglycemia and lower education level are also associated with a higher risk for experiencing SH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/dia.2025.0126","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T05:24:52Z","timestamp":1751433892000},"page":"881-889","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Characterizing Severe and Level 2 Hypoglycemia and Associated Risk Factors in Adults with Type 1 Diabetes Using Hybrid Closed-Loop Insulin Pumps"],"prefix":"10.1177","volume":"27","author":[{"given":"Micah","family":"Devore","sequence":"first","affiliation":[{"name":"Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Hepworth","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annika","family":"Agni","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5802-189X","authenticated-orcid":false,"given":"Wen","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie A.","family":"Amiel","sequence":"additional","affiliation":[{"name":"Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Kings College London, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon J.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1988-7046","authenticated-orcid":false,"given":"Yu Kuei","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.2337\/dci21-0043"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.2337\/db08-1084"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-0201"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-2215"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S007"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-0172"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(22)00212-1"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.4158\/ep-2018-0527"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-1285"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc23-1765"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040297"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-1561"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-2480"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12824"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2023.08.004"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-024-06310-5"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.17.7.697"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2020.0034"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-75079-5"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/19322968221085273"},{"issue":"1","key":"e_1_3_4_23_2","first-page":"43","article-title":"Organizational research: Determining appropriate sample size in survey research","volume":"19","author":"Kotrlik J","year":"2001","unstructured":"Kotrlik J, , Higgins C. Organizational research: Determining appropriate sample size in survey research. Information Technology, Learning, and Performance J, 2001; 19(1):43.","journal-title":"Information Technology, Learning, and Performance J"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/dme.15480"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.21.5.817"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2018.0364"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1172\/jci116302"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2022.0506"},{"key":"e_1_3_4_29_2","article-title":"Facilitators and barriers to hypoglycemia self-management in adults living with type 1 diabetes and using advanced diabetes technologies","author":"Lin YK","year":"2023","unstructured":"Lin YK, , Agni A, , Chuisano S, et al. 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