{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T08:43:33Z","timestamp":1792572213675,"version":"4.5.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"11","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K24 HL152440"],"award-info":[{"award-number":["K24 HL152440"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017618","name":"Division of Diabetes, Endocrinology, and Metabolic Diseases","doi-asserted-by":"publisher","award":["K01DK138273"],"award-info":[{"award-number":["K01DK138273"]}],"id":[{"id":"10.13039\/100017618","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To investigate the link between continuous glucose monitoring (CGM) metrics and risk of severe hypoglycemia and diabetic ketoacidosis (DKA) in individuals with type 1 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We pooled individual-level data from 10 studies of type 1 diabetes. From a 14-day baseline period, we derived CGM metrics (time in range [TIR] 70\u2013180 mg\/dL, time above range [TAR], time below range [TBR], sensor mean glucose, SD, and percent coefficient of variation [%CV]) and CGM-defined hypo- and hyperglycemic episodes. We used Cox regression to evaluate associations with severe hypoglycemia and DKA, with and without adjustment for HbA1c.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 1,550 participants, 65 severe hypoglycemia and 163 DKA events occurred over a median follow-up of 16 weeks. Higher TBR &amp;lt;70 and &amp;lt;54 mg\/dL, SD, %CV, and CGM-defined hypoglycemic episodes were associated with greater risk of severe hypoglycemia independent of HbA1c (e.g., hazard ratio [HR] 1.52 [1.29\u20131.79] per 1-SD higher TBR &amp;lt;70). Lower TIR and higher mean glucose, SD, %CV, TAR, and hyperglycemic episodes were associated with higher DKA risk; these associations were attenuated after HbA1c adjustment, but TIR, sensor mean glucose, and SD remained statistically and clinically significant (e.g., HR 0.76, 95% CI 0.60\u20130.97 per 1-SD higher TIR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>CGM hypoglycemic and glycemic variability metrics were associated with severe hypoglycemia risk independent of HbA1c, whereas TIR, mean glucose, and SD provided information for DKA risk beyond HbA1c. This supports the complementary value of CGM and HbA1c in risk assessment for severe hypoglycemia and DKA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-1042","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T20:14:27Z","timestamp":1786047267000},"page":"1991-1997","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":1,"title":["Continuous Glucose Monitoring Metrics and Risks of Severe Hypoglycemia and Diabetic Ketoacidosis in Type 1 Diabetes: A Pooled Analysis"],"prefix":"10.2337","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7769-4444","authenticated-orcid":false,"given":"Jiahuan Helen","family":"He","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 1 , Baltimore, MD"},{"name":"Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University 2 , Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2257-0480","authenticated-orcid":false,"given":"Natalie Daya","family":"Malek","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 1 , Baltimore, MD"},{"name":"Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University 2 , Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Zeger","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health 3 , Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8460-1617","authenticated-orcid":false,"given":"Justin B.","family":"Echouffo-Tcheugui","sequence":"additional","affiliation":[{"name":"Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University 2 , Baltimore, MD"},{"name":"Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University 4 , Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 1 , Baltimore, MD"},{"name":"Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University 2 , Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6923-7151","authenticated-orcid":false,"given":"Elizabeth","family":"Selvin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 1 , Baltimore, MD"},{"name":"Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University 2 , Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"2026102014523048400_B1","doi-asserted-by":"crossref","first-page":"S150","DOI":"10.2337\/dc26-S007","article-title":"7. 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Glycemic goals, hypoglycemia, and hyperglycemic crises: Standards of Care in Diabetes\u20142026","volume":"49","author":"American Diabetes Association Professional Practice Committee for Diabetes","year":"2025","journal-title":"Diabetes Care"},{"key":"2026102014523048400_B15","unstructured":"Food and Drug Administration.\n          \n          Diabetes mellitus: efficacy endpoints for clinical trials investigating antidiabetic drugs and biological products,2024. Accessed 5 February 2026. 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