Ruth S Weinstock1, Stephanie N DuBose2, Richard M Bergenstal3, Naomi S Chaytor4, Christina Peterson4, Beth A Olson3, Medha N Munshi5, Alysa J S Perrin2, Kellee M Miller6, Roy W Beck2, David R Liljenquist7, Grazia Aleppo8, John B Buse9, Davida Kruger10, Anuj Bhargava11, Robin S Goland12, Rachel C Edelen13, Richard E Pratley14, Anne L Peters15, Henry Rodriguez16, Andrew J Ahmann17, John-Paul Lock18, Satish K Garg19, Michael R Rickels20, Irl B Hirsch4. 1. State University of New York Upstate Medical University, Syracuse, NY. 2. Jaeb Center for Health Research, Tampa, FL. 3. Park Nicollet International Diabetes Center, Minneapolis, MN. 4. University of Washington, Seattle, WA. 5. Joslin Diabetes Center/Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 6. Jaeb Center for Health Research, Tampa, FL t1dstats@jaeb.org. 7. Rocky Mountain Diabetes and Osteoporosis Center, Idaho Falls, ID. 8. Northwestern University, Chicago, IL. 9. University of North Carolina School of Medicine, Chapel Hill, NC. 10. Henry Ford Medical Center, Detroit, MI. 11. Iowa Diabetes and Endocrinology Research Center, Des Moines, IA. 12. Naomi Berrie Diabetes Center at Columbia University Medical Center, New York, NY. 13. Regional Health Clinical Research, Rapid City, SD. 14. Florida Hospital Diabetes and Translational Research Institute for Metabolism and Diabetes, Orlando, FL. 15. Keck School of Medicine, University of Southern California, Los Angeles, CA. 16. University of South Florida, Tampa, FL. 17. Oregon Health and Science University, Portland, OR. 18. University of Massachusetts Memorial Medical Center, Worcester, MA. 19. Barbara Davis Center for Childhood Diabetes, Aurora, CO. 20. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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.
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.
Authors: Christopher M Ryan; Barbara E K Klein; Kristine E Lee; Karen J Cruickshanks; Ronald Klein Journal: J Diabetes Complications Date: 2016-08-14 Impact factor: 2.852
Authors: Elena Toschi; Christine Slyne; Kayla Sifre; Rachel O'Donnell; Jordan Greenberg; Astrid Atakov-Castillo; Sam Carl; Medha Munshi Journal: Diabetes Care Date: 2020-05-27 Impact factor: 19.112