Anders L Carlson1, Lauren G Kanapka2, Kellee M Miller2, Andrew J Ahmann3, Naomi S Chaytor4, Steven Fox5, Lisa Kiblinger6, Davida Kruger7, Carol J Levy8, Anne L Peters5, Michael R Rickels9, Maamoun Salam10, Viral N Shah11, Laura A Young12, Yogish C Kudva13, Richard Pratley14. 1. Park Nicollet International Diabetes Center, Minneapolis, MN, USA. 2. Jaeb Center for Health Research, Tampa, FL, USA. 3. Harold Schnitzer Diabetes Health Center at Oregon Health and Science University, Portland, OR, USA. 4. Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA. 5. Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. 6. Atlanta Diabetes Associates, Atlanta, GA, USA. 7. Henry Ford Medical Center, Detroit, MI, USA. 8. Icahn School of Medicine at Mount Sinai, New York, NY, USA. 9. Rodebaugh Diabetes Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 10. Washington University School of Medicine, St. Louis, MO, USA. 11. Barbara Davis Center for Diabetes, Aurora, CO, USA. 12. University of North Carolina, Chapel Hill, NC, USA. 13. Mayo Clinic, Rochester, MN, USA. 14. Advent Health, Orlando, FL, USA.
Abstract
BACKGROUND: Knowledge regarding the burden and predictors of hypoglycemia among older adults with type 1 diabetes (T1D) is limited. METHODS: We analyzed baseline data from the Wireless Innovations for Seniors with Diabetes Mellitus (WISDM) study, which enrolled participants at 22 sites in the United States. Eligibility included clinical diagnosis of T1D, age ≥60 years, no real-time continuous glucose monitoring (CGM) use in prior three months, and HbA1c <10.0%. Blinded CGM data from 203 participants with at least 240 hours were included in the analyses. RESULTS: Median age of the cohort was 68 years (52% female, 93% non-Hispanic white, and 53% used insulin pumps). Mean HbA1c was 7.5%. Median time spent in the glucose range <70 mg/dL was 5.0% (72 min/day) and <54 mg/dL was 1.6% (24 min/day). Among all factors analyzed, only reduced hypoglycemia awareness was associated with greater time spent <54 mg/dL (median time of 2.7% vs 1.3% [39 vs 19 minutes per day] for reduced awareness vs aware/uncertain, respectively, P = .03). Participants spent a mean 56% of total time in target glucose range of 70-180 mg/dL and 37% of time above 180 mg/dL. CONCLUSIONS: Over half of older T1D participants spent at least an hour a day with glucose levels <70 mg/dL. Those with reduced hypoglycemia awareness spent over twice as much time than those without in a serious hypoglycemia range (glucose levels <54 mg/dL). Interventions to reduce exposure to clinically significant hypoglycemia and increase time in range are urgently needed in this age group.
BACKGROUND: Knowledge regarding the burden and predictors of hypoglycemia among older adults with type 1 diabetes (T1D) is limited. METHODS: We analyzed baseline data from the Wireless Innovations for Seniors with Diabetes Mellitus (WISDM) study, which enrolled participants at 22 sites in the United States. Eligibility included clinical diagnosis of T1D, age ≥60 years, no real-time continuous glucose monitoring (CGM) use in prior three months, and HbA1c <10.0%. Blinded CGM data from 203 participants with at least 240 hours were included in the analyses. RESULTS: Median age of the cohort was 68 years (52% female, 93% non-Hispanic white, and 53% used insulin pumps). Mean HbA1c was 7.5%. Median time spent in the glucose range <70 mg/dL was 5.0% (72 min/day) and <54 mg/dL was 1.6% (24 min/day). Among all factors analyzed, only reduced hypoglycemia awareness was associated with greater time spent <54 mg/dL (median time of 2.7% vs 1.3% [39 vs 19 minutes per day] for reduced awareness vs aware/uncertain, respectively, P = .03). Participants spent a mean 56% of total time in target glucose range of 70-180 mg/dL and 37% of time above 180 mg/dL. CONCLUSIONS: Over half of older T1Dparticipants spent at least an hour a day with glucose levels <70 mg/dL. Those with reduced hypoglycemia awareness spent over twice as much time than those without in a serious hypoglycemia range (glucose levels <54 mg/dL). Interventions to reduce exposure to clinically significant hypoglycemia and increase time in range are urgently needed in this age group.
Entities:
Keywords:
continuous glucose monitoring; hyperglycemia; hypoglycemia; type 1 diabetes
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