Interoception Mitigates the Impact of Hypoglycemia Exposure on Symptom Recognition in Adults with Type 1 Diabetes

Introduction and Objective: Hypoglycemia exposure lowers the glycemic threshold for symptom recognition (i.e., Symptom Level), contributing to impaired awareness of hypoglycemia (IAH). Interoception—the ability to sense and interpret bodily signals— is related to lower IAH risk. We tested the hypothesis that interoception moderates the association between hypoglycemia exposure and autonomic Symptom Level. Methods: Adults with type 1 diabetes (T1D) completed 30-day continuous glucose monitoring and assessments of interoception (MAIA-2) and Symptom Level (HypoA-Q). Proportional odds logistic regression tested if interoception moderated the association between hypoglycemia exposure (%Time <60 mg/dL) and Symptom Level, adjusting for covariates. Results: Among 717 adults with T1D (mean age: 44 ± 15 years; T1D duration: 25 ± 15 years), hypoglycemia exposure (%Time <60 mg/dL) was 0.8 ± 1.4%. Higher exposure was associated with lower Symptom Levels (OR: 0.48, CI: 0.33-0.71, p < 0.001). Interoception was not associated with Symptom Level (OR: 0.90, CI: 0.75-1.08). However, greater interoception reduced the impact of hypoglycemia exposure on Symptom Level (OR: 1.13, CI: 1.01-1.26, p < 0.05). Conclusion: Interoception moderated the association between hypoglycemia exposure and Symptom Level. Targeting interoception may offer a novel approach for prevention and management of IAH. Disclosure A.M. Matus: None. A. Agni: None. E. Hepworth: None. S.A. Amiel: Advisory Panel; Vertex Pharmaceuticals Incorporated. Other Relationship; Vertex Pharmaceuticals Incorporated. Research Support; National Institutes of Health. M.R. Rickels: Consultant; Vertex Pharmaceuticals Incorporated, Sernova, Corp. Research Support; Dompé, Tandem Diabetes Care, Inc. Consultant; Novo Nordisk. B. Riegel: None. J.A. Shaw: None. J. Speight: Advisory Panel; Vertex Pharmaceuticals Incorporated. Y. Lin: None. Funding National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007314); National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (U01DK135120); National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (K23DK129724)