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

2023; Wiley; Volume: 71; Issue: 7 Linguagem: Inglês

10.1111/jgs.18341

1532-5415

Anne‐Sophie Boureau, Béatrice Guyomarch, Pierre Gourdy, Ingrid Allix, Cédric Annweiler, Nathalie Cervantes, Guillaume Chapelet, Isabelle Delabrière, Sophie Guyonnet, Rachel Litke, Marc Paccalin, A. Penfornis, Pierre‐Jean Saulnier, Matthieu Wargny, Samy Hadjadj, Laure de Decker, Bertrand Cariou,

Hyperglycemia and glycemic control in critically ill and hospitalized patients

Abstract Background 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. Methods 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). Results The mean age of the 141 analyzed patients was 81.5 ± 5.3 years and 56.7% were male. The mean baseline HbA 1c 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. Conclusion 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.