Tight control associated with more frequent and persistent hypoglycemia in elderly persons with diabetes mellitus

Reference

Bouillet B, Tscherter P, Vaillard L, et al. Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes. Age Ageing 2021;50(6):2088-2093.

Synopsis

This study, which took place in 6 nursing homes in France, recruited 42 persons with type 2 diabetes who were older than 65 years and taking medications capable of inducing hypoglycemia (eg, sulfonylureas, repaglinide, or insulin). The researchers defined hypoglycemia as a capillary glucose level of less than 70 mg/dL (3.9 mmol/L) and severe hypoglycemia as a glucose level of less than 54 mg/dL (3 mmol/L). The participants wore a continuous glucose monitor for up to 14 days. The monitor did not reveal the readings to the participants or the care staff. Most of the participants were women (69%) and their average age was 87.4 years. The care staff identified 5 hypoglycemic events in 4 participants through episodic capillary glucose monitoring; the continuous monitoring identified 242 events in 33 (79%) of the participants. Seven participants (17%) spent more than 20% of an entire day in a hypoglycemic state. Nineteen participants (45%) experienced severe hypoglycemia. After adjusting for sex, comorbidities, weight, treatment, and functional status, the authors report that the glycated hemoglobin (HbA1C) level was inversely associated with the number of events and with time spent in hypoglycemia (ie, a lower HbA1C was associated with more events).