Avoiding hypoglycaemia: a new target of care for elderly diabetic patients

Abstract

Optimising glycaemic control to prevent diabetes-associated complications has received much attention. The associated risk of iatrogenic hypoglycaemia, however, is inevitable and can have a significant impact on health. The prevalence of iatrogenic hypoglycaemia tends to increase with advancing age. Elderly people are intrinsically prone to hypoglycaemia. Ageing attenuates the glucose counter-regulatory and symptomatic response to hypoglycaemia, particularly in the presence of a longer duration of diabetes. Multiple co-morbidities and polypharmacy correlated with advancing age also increase the hypoglycaemic risk. In addition to the acute adverse effects of hypoglycaemia, such as fall with injury, cardiovascular events and mortality, a hypoglycaemic episode can have long-term consequences. Repeated episodes may have a significant psychological impact and are also a risk factor for dementia. Because of the heterogeneous health status of the elderly, not all will benefit from optimal glycaemic control. Setting an individual glycaemic target and formulating a management plan that takes account of the patient's circumstances combined with balancing the benefit and risk of diabetes intervention to avoid hypoglycaemia is a more practical approach to the management of elderly diabetic patients.

Profiling risk factors of patients diagnosed with type 2 diabetes awaiting outpatient diabetes specialist consultant appointment, a narrative review

“…Hypoglycaemia is defined as an acute complication with blood glucose level reduced to < 3.9mmol/L and/or a person is symptomatic . Duration of type 2 diabetes was linked with an increased risk of hypoglycaemic events in two other studies ( Huang et al, 2011 ;Wong, 2015 ). This finding is again evidenced in a cross-sectional study of 9,094 patients with type 2 diabetes, who experienced an increased risk of hypoglycaemia if their HbA1c range was < 6% (42mmol/mol) and/or > 9% (75mmol/mol) ( Lipska et al, 2013 ).…”

Frequency and predisposing factors for drug-induced hypoglycemia in patients with type-2 diabetes mellitus

“…Furthermore, an increased number of comorbid conditions in elderly patients can lead to polypharmacy that further increases the chances of drug interactions resulting in increased susceptibility of hypoglycemia. [1819] A study conducted by Kagansky et al . also documented similar observations concerning drug-induced hypoglycemia among elderly diabetic patients.…”

Diabetes type 2 diabetes in the elderly – solved and unsolved questions

“…Особое внимание исследователей и клиницистов уделяется проблеме гипогликемии у пожилых пациен-тов с СД [20][21][22][23]. Истинную распространенность гипо-гликемии в пожилом возрасте трудно установить из-за различий в ее определении, к тому же в большинстве ис-следований учитывалась лишь распознанная гипоглике-мия.…”

“…Данная особенность может привести к пролонгации гипогликемии. Помимо острых неблагоприятных последствий гипогликемии, таких как падение с травмами, сердечно-сосудистые катастрофы, гипогликемический эпизод может иметь долгосрочные последствия [20,21,25]. Повторяющиеся гипогликемии могут оказать значительное психологи-ческое воздействие, а также являются фактором риска развития деменции [26].…”

“…Каждый из факторов риска гипогли-кемии должен рассматриваться при определении вари-антов лечения диабета и выборе индивидуальных целей. Сведение к минимуму риска гипогликемии является одним из главных приоритетов в лечении СД у пожилых людей [20].…”