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. 2016 Apr;39(4):603-10.
doi: 10.2337/dc15-1426. Epub 2015 Dec 17.

Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 Diabetes

Ruth S Weinstock  1 , Stephanie N DuBose  2 , Richard M Bergenstal  3 , Naomi S Chaytor  4 , Christina Peterson  4 , Beth A Olson  3 , Medha N Munshi  5 , Alysa J S Perrin  2 , Kellee M Miller  6 , Roy W Beck  2 , David R Liljenquist  7 , Grazia Aleppo  8 , John B Buse  9 , Davida Kruger  10 , Anuj Bhargava  11 , Robin S Goland  12 , Rachel C Edelen  13 , Richard E Pratley  14 , Anne L Peters  15 , Henry Rodriguez  16 , Andrew J Ahmann  17 , John-Paul Lock  18 , Satish K Garg  19 , Michael R Rickels  20 , Irl B Hirsch  4 ; T1D Exchange Severe Hypoglycemia in Older Adults With Type 1 Diabetes Study Group
Affiliations

Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 Diabetes

Ruth S Weinstock et al. Diabetes Care. 2016 Apr.

Abstract

Objective: Severe hypoglycemia is common in older adults with long-standing type 1 diabetes, but little is known about factors associated with its occurrence.

Research design and methods: A case-control study was conducted at 18 diabetes centers in the T1D Exchange Clinic Network. Participants were ≥60 years old with type 1 diabetes for ≥20 years. Case subjects (n = 101) had at least one severe hypoglycemic event in the prior 12 months. Control subjects (n = 100), frequency-matched to case subjects by age, had no severe hypoglycemia in the prior 3 years. Data were analyzed for cognitive and functional abilities, social support, depression, hypoglycemia unawareness, various aspects of diabetes management, C-peptide level, glycated hemoglobin level, and blinded continuous glucose monitoring (CGM) metrics.

Results: Glycated hemoglobin (mean 7.8% vs. 7.7%) and CGM-measured mean glucose (175 vs. 175 mg/dL) were similar between case and control subjects. More case than control subjects had hypoglycemia unawareness: only 11% of case subjects compared with 43% of control subjects reported always having symptoms associated with low blood glucose levels (P < 0.001). Case subjects had greater glucose variability than control subjects (P = 0.008) and experienced CGM glucose levels <60 mg/dL for ≥20 min on 46% of days compared with 33% of days in control subjects (P = 0.10). On certain cognitive tests, case subjects scored worse than control subjects.

Conclusions: In older adults with long-standing type 1 diabetes, greater hypoglycemia unawareness and glucose variability are associated with an increased risk of severe hypoglycemia. A study to assess interventions to prevent severe hypoglycemia in high-risk individuals is needed.

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