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The CRASH online survey examined the experience and treatment of a severe hypoglycemic event (SHE) in people with T1DM or insulin-treated T2DM (PWD) or caregivers (CG). Eligible participants experienced ≥1 SHE in the last 3 years with insulin treatment at the time of event. Reported here are results from PWD aged ≥65 (T1DM 74, T2DM 104) and CG (T1DM 95, T2DM 231) from Canada, Germany, Spain, UK, and USA. During the last SHE, reported glucagon use was low for T1DM (9.5%) and T2DM (7.5%); primary reason reported was no prescription available or filled (T1DM 24.3%, T2DM 29.3%). Of those who ever discussed SHE at their healthcare provider (HCP) visit (T1DM 138, T2DM 243), less than half (T1DM 41.3%, T2DM 34.2%) reported discussion of SHE at every HCP visit. No discussion of the most recent SHE occurred for 34.3% (T1DM) and 31.0% (T2DM). During the most recent SHE many felt unprepared (T1DM 35.5%, T2DM 47.2%), scared (T1DM 60.9%, T2DM 64.2%), and helpless (T1DM 39.1%, T2DM 51.3%). After the last SHE, changes were reported to insulin regimens, meal plans, carrying sugar/sweets, checking blood glucose more often or using continuous glucose monitors, and increasing access to glucagon. Clinical guidelines recommending discussion of hypoglycemia at each HCP visit for PWD at risk for SHE are not being met and should occur, and CGs should be included in preparedness strategies. Disclosure F.J. Snoek: Advisory Panel; Self; Abbott, Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care. Research Support; Self; Sanofi. E. Spaepen: None. D.M. Bushnell: None. C.J. Child: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. Z. Balantac: Other Relationship; Self; Eli Lilly and Company. B. Mitchell: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. M. Peyrot: Advisory Panel; Self; Eli Lilly and Company. Consultant; Self; CeQur Corporation, Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company. Funding Eli Lilly and Company

Injectable glucagon (IG) is challenging to use for caregivers of a person with diabetes (PWD) in stressful severe hypoglycemia (SH) rescue. We evaluated user preference for nasal glucagon (NG) and IG devices after treating simulated SH. The PWD trained arm was adult PWDs trained to use NG or IG, then PWDs trained their caregivers how to use it; 1 week later, caregivers administered the device to a life-like manikin exhibiting SH in a simulated real life setting with distractions creating urgency. The untrained arm was adults not associated with a PWD, but willing to assist - not trained, but shown the device just presimulation. After 1 week, the process was repeated with the other device. We assessed perceptions of simulation participants and PWDs via comparative device questionnaires, completed after videos of both simulations were viewed after the 2nd simulation (no confirmation of success provided). NG was rated more preferred by those with successful doses of NG or IG. PWDs indicated that they felt safer with NG even with successful IG dosing (Table). Untrained users were as successful as PWD-trained in dosing NG, while there were no IG successes without training. None of the few who preferred IG gave a successful IG dose, whereas the few successful IG-users preferred NG or stated no preference. Being PWD-trained was not critical for success with NG, and ease of preparation and use likely contributed to overall preference. Disclosure J. Settles: Employee; Self; Eli Lilly and Company. C.J. Child: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. S.K. Bajpai: Employee; Self; Eli Lilly and Company. E. Spaepen: Consultant; Self; Eli Lilly and Company. J.G. Suico: Employee; Self; Eli Lilly and Company. Funding Eli Lilly and Company

The CRASH study examines the experience and treatment of a severe hypoglycemia event (SHE) among people with T1DM (ppl w/T1DM) or insulin-treated ppl w/T2DM and caregivers. The online survey was conducted in 8 countries. To be eligible in the global study, ppl had experienced or cared for a person who had ≥1 SHE in the last 3 years. SHE was defined as low blood glucose requiring assistance for recovery. Here, we report U.S. data for 220 ppl with diabetes (n=110 T1DM; n=110 T2DM). Sixty-five (59.1%) ppl w/T2DM used insulin for >5 years, while mean (SD) duration of diabetes was 30.6 (16.6) years for ppl w/T1DM and 16.0 (8.7) years for ppl w/T2DM. Forty (36.4%) ppl w/T1DM and 22 (20.0%) ppl w/T2DM reported impaired awareness (Gold score ≥4). During the last SHE, glucagon use was low (T1DM [8.2%]; T2DM [3.6%]); reasons for not using glucagon were not having a prescription (T1DM [40.0%]; T2DM [59%]) or it was unavailable (T1DM [20.0%]; T2DM [17.1%]). Also, ppl w/T1DM (75.5%) and ppl w/T2DM (83.6%) reported using oral glucose only for treatment; use of healthcare provider assistance was low. The main causes reported for a SHE were eating less than planned (T1DM [27.3%]; T2DM [47.3%]) or exercising more than planned (T1DM [21.8%]; T2DM [20.0%]). Results indicate that treatment of a SHE mainly occurred outside the healthcare system with fewer ppl having glucagon as an option for recovery. Disclosure F.J. Snoek: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care. Research Support; Self; Sanofi. Speaker's Bureau; Self; Lilly Diabetes. A. Jiletcovici: Employee; Self; Eli Lilly and Company. D.M. Bushnell: None. C.J. Child: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. S.K. Bajpai: Employee; Self; Eli Lilly and Company. E. Spaepen: Consultant; Self; Eli Lilly and Company. J. Thomas: Employee; Self; Eli Lilly and Company. Z. Balantac: Other Relationship; Self; Eli Lilly and Company. M. Peyrot: Advisory Panel; Self; Eli Lilly and Company. Consultant; Self; Calibra Medical. Research Support; Spouse/Partner; Eli Lilly and Company. B. Mitchell: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.