Nocturnal hypoglycemia is underdiagnosed in older people with insulin-treated type 2 diabetes: The HYPOAGE observational study

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 71; no. 7; pp. 2107 - 2119
• Main Authors: Boureau, Anne-Sophie, Guyomarch, Béatrice, Gourdy, Pierre, Allix, Ingrid, Annweiler, Cédric, Cervantes, Nathalie, Chapelet, Guillaume, Delabrière, Isabelle, Guyonnet, Sophie, Litke, Rachel, Paccalin, Marc, Penfornis, Alfred, Saulnier, Pierre-Jean, Wargny, Matthieu, Hadjadj, Samy, de Decker, Laure, Cariou, Bertrand
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-07-2023; Wiley
• Subjects: Aged; Aged, 80 and over; Blood Glucose - analysis; Blood Glucose Self-Monitoring; Cognitive ability; Congestive heart failure; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Elder care; Female; Geriatrics; Glucose; Glucose monitoring; Humanities and Social Sciences; Humans; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemia - epidemiology; Hypoglycemic Agents - adverse effects; Insulin; Insulin - adverse effects; Male; Observational studies; Older people; Population studies; Prospective Studies; Psychology; older patients; type 2 diabetes; glycemic control; basal insulin analogues; continuous glucose monitoring; hypoglycemia
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.18341

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.
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).
The mean age of the 141 analyzed patients was 81.5 ± 5.3 years and 56.7% were male. The mean baseline HbA
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.
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.