Abstract Body (Do not enter title and authors here): Introduction: Individuals with type 1 diabetes (T1D) complicated by impaired awareness of hypoglycemia (IAH) are at significantly increased risk for severe hypoglycemia: a marker of high risk of CVD. Tailoring interventions to promote hypoglycemia avoidance is difficult due to self-care heterogeneity among those with T1D.
Aims: Map self-care heterogeneity among adults with T1D into behavioral phenotypes and identify common barriers to hypoglycemia avoidance within each phenotype.
Methods: An explanatory sequential mixed methods study was performed in 200 adults with T1D. Participants reported personal, clinical, and social determinants of health, hypoglycemia awareness, and self-care of diabetes (Self-Care of Diabetes Inventory, scored 0-100, adequate ≥70) . Cluster analysis was performed to identify self-care clusters. Then, directed content analysis was applied to individual, semi-structured interviews performed in a subsample from each cluster with IAH (n=20). Findings were integrated to develop a typology of self-care and identify barriers to hypoglycemia avoidance within each phenotype.
Results: Three self-care phenotypes were identified. Experts (n=70; mean age: 45±17 years; 24% Black; T1D duration: 25±16 years; HbA_1c: 7.36±1.67%; IAH: 20%) performed all aspects of self-care adequately (Maintenance: 84.9±8.8; Monitoring: 85.1±8.8; Management: 72.5±10). Yet, Experts with IAH reported purposefully delaying treatment of hypoglycemia due to lack of concern. Those with Inconsistent self-care (n= 112; mean age 37±14 years; 20% Black: T1D duration: 21±13 years; HbA_1c: 7.26±1.16%; IAH: 30%) performed only self-care maintenance adequately (Maintenance: 78.6±8.9; Monitoring: 65.6±9.8; Management: 56.8±10.1). Those with Inconsistent self-care and IAH reported passive self-care monitoring that inhibited effective hypoglycemic management. Novices (n= 18; mean age 27±7 years; 50% Black: T1D duration: 16±8 years; HbA_1c: 8.97±2.80%; IAH: 28%) reported difficulty performing all aspects of self-care (Maintenance: 51.9±7.7, Monitoring: 56.9±12.9, Management: 44.5±6.3) due to economic and psychosocial barriers.
Conclusions: Self-care heterogeneity mapped onto three phenotypes that can be used to better understand patient barriers to hypoglycemia avoidance and hypoglycemia awareness restoration. This typology provides a framework for investigating how best to tailor IAH treatment considerate of self-care.