Abstract
Background

There is a lack of real-life data regarding the frequency and predictive factors of hypoglycemia in older patients with type 2 diabetes (T2D). This study aimed to determine the frequency and predictors of hypoglycemia in older patients with insulin-treated T2D.

Methods

This prospective multicenter study included 155 insulin-treated T2D patients aged 75 years and older with ≥2 self-monitoring of blood glucose (SMBG) daily controls. Participants underwent a geriatric and diabetic assessment and received ambulatory blinded continuous glucose monitoring (CGM) for 28 consecutive days with FreeStyle Libre Pro® sensor. Study population (n = 141) has >70% CGM active time. Multivariable logistic regressions were used to identify factors associated with SMBG confirmed hypoglycemia (≥70 mg/dL) and with nocturnal level 2 time below range (glucose concentration <54 mg/dL during ≥15 consecutive min between 0.00 and 6.00 am).

Results

The mean age of the 141 analyzed patients was 81.5 ± 5.3 years and 56.7% were male. The mean baseline HbA1c was 7.9% ± 1.0%. After geriatric assessment, 102 participants (72.3%) were considered as complex and 39 (27.7%) as healthy. The primary endpoint (confirmed SMBG <70 mg/dL) occurred in 37.6% patients. In multivariable analysis, the risk of SMBG-confirmed hypoglycemia was positively associated with a longer duration of diabetes (OR (+1 year) =1.04, (1.00–1.08), p = 0.04) and glycemic variability assessed by CGM (CV %) (OR (+1%) = 1.12, [1.05–1.19], p = <0.001). Nighty-two patients (65.2%) experienced nocturnal time in hypoglycemia (i.e., <54 mg/dL during ≥15 consecutive min between midnight and 6 a.m.). In multivariable analyses, cognitive impairment (OR: 9.31 [2.59–33.4]), heart failure (OR: 4.81 [1;48–15.6]), and depressive disorder (OR: 0.19 [0.06–0.53]) were associated with nocturnal time in hypoglycemia.

Conclusion

Nocturnal hypoglycemia is very common and largely underdiagnosed in older patients with insulin-treated T2D. CGM is a promising tool to better identify hypoglycemia and adapt diabetes management in this population.

Key points
Around a third of insulin-treated older patients with type 2 diabetes experienced hypoglycemia (<70 mg/dL) based on self-monitoring of blood glucose.
When using continuous glucose monitoring (CGM), 65% of patients experienced nocturnal time below range (glucose concentration <54 mg/dL during ≥15 consecutive min).
Cognitive impairment and heart failure were risk factors for nocturnal time below range.

Adrenaliinioireet alkavat, kun verensokeri alittaa tason 3,3–3,5 mmol/l. Oireet ovat seuraavat:

vapina, käsien tärinä
hermostuneisuus
sydämentykytys (tiheä pulssi)
hikoilu
nälän tunne
heikotus.
Oireet ovat varsin tyypillisiä, ja diabetesta sairastava oppii tunnistamaan ne nopeasti. …

Hermosto-oireet alkavat, kun verensokeri on laskenut tasolle 2,5–2,8 mmol/l. Oireet ovat seuraavat:

väsymys, uupumus
keskittymisvaikeus, ajatus ei kulje
päänsärky
uneliaisuus
huimaus, pyörrytys
epätavallinen tai riitaisa käytös
näön hämärtyminen, näkeminen kahtena
pahimmassa tapauksessa kouristuksia ja tajuttomuus (jos verensokeri on laskenut alle tason 2 mmol/l).