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

Ruth S Weinstock; Stephanie N DuBose; Richard M Bergenstal; Naomi S Chaytor; Christina Peterson; Beth A Olson; Medha N Munshi; Alysa J S Perrin; Kellee M Miller; Roy W Beck; David R Liljenquist; Grazia Aleppo; John B Buse; Davida Kruger; Anuj Bhargava; Robin S Goland; Rachel C Edelen; Richard E Pratley; Anne L Peters; Henry Rodriguez; Andrew J Ahmann; John-Paul Lock; Satish K Garg; Michael R Rickels; Irl B Hirsch

doi:10.2337/dc15-1426

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

Journal article

Open access

Peer reviewed

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

Ruth S Weinstock, Stephanie N DuBose, Richard M Bergenstal, Naomi S Chaytor, Christina Peterson, Beth A Olson, Medha N Munshi, Alysa J S Perrin, Kellee M Miller, Roy W Beck, …

Diabetes care, Vol.39(4), pp.603-610

04/2016

DOI: https://doi.org/10.2337/dc15-1426

Handle:

https://hdl.handle.net/2376/109996

PMID: 26681721

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Abstract

Hypoglycemic Agents - therapeutic use

C-Peptide - blood

Glycated Hemoglobin A - metabolism

Humans

Middle Aged

Risk Factors

Male

Diabetes Mellitus, Type 1 - complications

Case-Control Studies

Diabetes Mellitus, Type 1 - drug therapy

Diabetes Mellitus, Type 1 - blood

Hypoglycemia - complications

Female

Aged

Hypoglycemia - blood

Blood Glucose - metabolism

Severe hypoglycemia is common in older adults with long-standing type 1 diabetes, but little is known about factors associated with its occurrence. 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. 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. 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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Title: Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 Diabetes
Creators: Ruth S Weinstock - State University of New York Upstate Medical University, Syracuse, NY
Stephanie N DuBose - Jaeb Center for Health Research, Tampa, FL
Richard M Bergenstal - Park Nicollet International Diabetes Center, Minneapolis, MN
Naomi S Chaytor - University of Washington, Seattle, WA
Christina Peterson - University of Washington, Seattle, WA
Beth A Olson - Park Nicollet International Diabetes Center, Minneapolis, MN
Medha N Munshi - Joslin Diabetes Center/Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Alysa J S Perrin - Jaeb Center for Health Research, Tampa, FL
Kellee M Miller - Jaeb Center for Health Research, Tampa, FL t1dstats@jaeb.org
Roy W Beck - Jaeb Center for Health Research, Tampa, FL
David R Liljenquist - Rocky Mountain Diabetes and Osteoporosis Center, Idaho Falls, ID
Grazia Aleppo - Northwestern University, Chicago, IL
John B Buse - University of North Carolina School of Medicine, Chapel Hill, NC
Davida Kruger - Henry Ford Medical Center, Detroit, MI
Anuj Bhargava - Iowa Diabetes and Endocrinology Research Center, Des Moines, IA
Robin S Goland - Naomi Berrie Diabetes Center at Columbia University Medical Center, New York, NY
Rachel C Edelen - Regional Health Clinical Research, Rapid City, SD
Richard E Pratley - Florida Hospital Diabetes and Translational Research Institute for Metabolism and Diabetes, Orlando, FL
Anne L Peters - Keck School of Medicine, University of Southern California, Los Angeles, CA
Henry Rodriguez - University of South Florida, Tampa, FL
Andrew J Ahmann - Oregon Health and Science University, Portland, OR
John-Paul Lock - University of Massachusetts Memorial Medical Center, Worcester, MA
Satish K Garg - Barbara Davis Center for Childhood Diabetes, Aurora, CO
Michael R Rickels - University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Irl B Hirsch - University of Washington, Seattle, WA
Publication Details: Diabetes care, Vol.39(4), pp.603-610
Academic Unit: Medical Education and Clinical Science, Department of
Publisher: United States
Identifiers: 99900547292501842
Language: English
Resource Type: Journal article