IN BRIEF Glucagon is an invaluable tool for patients with type 1 diabetes who experience severe hypoglycemia, but little is known about the actual use of rescue glucagon in this patient population. This survey study found that patients with type 1 diabetes were not adequately prescribed glucagon or educated about the use of glucagon, and patients reported various administration issues in using it. These results strongly suggest the need for standards of practice to increase the prescribing of glucagon and the provision of initial and ongoing education about its use and administration and the development of a glucagon rescue device or a glucagon product that would eliminate the complexity of its current formulation and packaging.

ObjectivesFear of hypoglycaemia (FoH) has been associated with suboptimal diabetes management and health outcomes. This study investigated factors associated with behavioural and emotional aspects of FoH among adults living with type 1 diabetes (T1D) mellitus.DesignCross-sectional study.SettingOnline survey hosted on T1D Exchange Glu, an online community for patients living with T1D mellitus.MeasuresThe Hypoglycaemia Fear Survey II-short form and the Hypoglycaemic Attitudes and Behaviour Scale were used to assess FoH. Multivariable regressions were performed on assessment scores.ResultsThe study included 494 participants (mean±SD age 43.9±12.2 years, duration of T1D mellitus 16.6±16.8 years, self-reported glycosylated hemoglobin (HbA1c) 6.9%±0.8% (52±9 mmol/mol)), 63% men, 89% on insulin pump, 25% experienced a severe hypoglycaemic event in the last 6 months. Multivariable regression analyses showed higher anxiety, depression severity and diabetes distress were independently associated with FoH (all p<0.01). Longer diabetes duration was associated with lower FoH (p<0.01). Past experience with severe hypoglycaemia was associated with higher worry of hypoglycaemia (p<0.01) but not avoidance behaviour (ns).ConclusionsThese results highlighted the multifaceted nature of FoH, which warrants further discussion between providers and patients to uncover drivers of and actions required to reduce FoH and improve patient care and outcomes.

Fear of hypoglycemia (FoH) contributes to poor behavioral and glycemic outcomes. The ADA position statement on psychosocial care for people with diabetes recommends screening for FoH, with referral if positive. A clinically useful screener for FoH does not exist, hindering further actions by clinicians to address FoH in their patients. As part of a multi–phase study to develop a validated screener for FoH, we conducted semi–structured interviews with 10 healthcare providers (HCPs) (6 endocrinologists, 4 certified diabetes educators) who treat patients with T1D. The objective was to understand current clinical methods of identifying, diagnosing, and/or assessing FoH, HCP perceptions of T1D patients’ fear of, and experience with, hypoglycemia. Interviews were transcribed, de–identified, and thematically analyzed. Key themes were summarized for each interviewee and common themes across interviews were identified. All HCPs reported assessing patients for FoH through discussion. Most HCPs (7/10) did not use formal screeners for psychosocial issues. Instead, they evaluated patients with open ended questions about their feelings and experiences about low blood sugar. Some HCPs identified FoH behaviors based on CGM and insulin pump usage data; however, this method was not applicable for patients not using these technologies. Most HCPs (9/10) were not familiar with Blood Glucose Awareness Training as a formal program, which is recommended by the ADA to re–establish awareness of hypoglycemia and reduce FoH. Most HCPs made mental health referral decisions after observing anxiety, depression, or chronic poor management behaviors. Results suggest that although clinicians are aware of FoH, due to the lack of a formal screening tool, most HCPs rely on subjective judgment to determine the need for further psychosocial care referral. Creation of a screener will provide a standardized tool to better implement the ADA position statement of psychosocial care on the management of FoH. Disclosure B. Mitchell: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. J. Bispham: None. A. Hughes: None. J. Liu: None. M. Perez-Nieves: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. J. Poon: Employee; Self; Eli Lilly and Company. L. Fan: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. A. McAuliffe-Fogarty: None. Funding Eli Lilly and Company

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Background: Half-unit pens offer the ability to dose insulin more precisely. Information about half-unit pen use and evidence of their benefits and drawbacks is limited. This study aims to characterize people with type 1 diabetes (T1D) who have used (current/former = EVER) vs. those who have never used halfunit pens (NEVER users) and to understand their perspective. Methods: An observational cross-sectional online survey was administered through T1D Exchange's online patient community, myGlu.org, to understand the use of half-unit insulin pens. Results: The 278 adult participants (156 EVER, 122 NEVER) had mean age of 41.8±12.7 years, body mass index of 26.0±3.8 kg/m 2 , glycated hemoglobin of 6.3%±1.0%, and 55% were male. EVER users had T1D for shorter duration than NEVER users (p<0.001). EVER users were less likely to use continuous subcutaneous insulin infusion (p<0.001) and more likely to start correcting high blood glucose at a lower level (p<0.001) and low blood glucose at a higher level (p<0.001). The highest ranked benefits of halfunit pen reported by its current users (N=131) included prevention of hyperglycemia (40.5%), less anxiety or worry (23.7%), and prevention of hypoglycemia (16.8%). Conclusions: Half-unit insulin pen is perceived as an insulin device that may help people with T1D to avoid hypo-and hyperglycemic events and decrease their level of disease worry and anxiety. This study highlights the need for patients and health care providers to understand the benefits of half-unit pens while considering options for individualized diabetes management.