Detection of asymptomatic drug-induced hypoglycemia using continuous glucose monitoring in older people – Systematic review

Mattishent, Katharina; Loke, Yoon K.

doi:10.1016/j.jdiacomp.2018.05.005

Cited by 24 publications

(31 citation statements)

References 19 publications

(16 reference statements)

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“…An international consensus on clinical targets for continuous glucose monitoring data was published in June 2019, highlighted that older adults with diabetes should spend less than 15 minutes per day in the hypoglycaemic range (<3.9mmol/L) ( 48 ). This is of particular significance, as hypoglycaemic episodes are often missed in older people with diabetes ( 49 ).…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents

Mattishent

Loke

2021

Front. Endocrinol.

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AimsWe conducted a meta-analysis of serious adverse events (dementia, macro- and micro-vascular events, falls and fractures, and death) associated with hypoglycemia in older patients treated with glucose lowering drugs.Materials and MethodsMeta-analysis of studies reporting on hypoglycemia and adverse events. The search included studies from two previously published systematic reviews, and an updated search of MEDLINE and EMBASE from April 2014 to November 2019. We assessed study validity based on ascertainment of hypoglycemia, adverse events and adjustment for confounders, and conducted a random effects meta-analyses, assessing heterogeneity using the I2 statistic.ResultsWe included 44 studies involving 2,507,434 participants. Most of the studies used adjusted analysis for confounders and hypoglycaemic events were typically identified based on healthcare databases (severe events). Hypoglycemia was associated with increased likelihood of death in a meta-analysis of eighteen studies, pooled OR 2.02 (95% Confidence Interval 1.75–2.32). Studies assessing mortality signal a time-response relationship with a higher risk of adverse events occurring within the first 90 days after hypoglycemia. Our meta-analysis of nine studies demonstrated that hypoglycaemic episodes were associated with dementia – pooled OR 1.50 (95% CI 1.29–1.74). Our meta-analysis of nineteen studies demonstrated associations between hypoglycaemia and macrovascular complications, pooled OR 1.81 (95% CI 1.70–1.94), and microvascular complications (two studies) pooled OR 1.77 (95% CI 1.49–2.10). There is also an association between hypoglycemia and cardiovascular death (six studies) – pooled OR 2.11 (95% CI 1.55 to 2.87). Similarly, our meta-analysis of six studies demonstrated an association between hypoglycemia and falls and fractures, pooled OR 1.78 (95% CI 1.44–2.21) and 1.68 (95% CI 1.37–2.07) respectively.ConclusionThis meta-analysis confirms previously reported concerns of serious harm following hypoglycemia, especially in the immediate time period after a hypoglycaemic event. Avoidance of hypoglycaemic episodes should be a priority in this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents

Mattishent

Loke

2021

Front. Endocrinol.

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“…Decreased time in hypoglycemia (13 out of 15 studies) in Type 1 diabetes as well as increased time in range (TIR) as a result of CGM usage were also observed in a systematic review by De Ridder et al ( 33 ). Other study reported that adult patients with Type 1 diabetes who use CGM perceive improvements in their quality of life, especially related to hypoglycemia fear ( 22 ). Only a few studies have found positive outcomes regarding hypoglycemia when using CGM (reduction in nocturnal hypoglycemia episodes by 54% with is CGM vs. SMBG (−0·29 ± 0·08 h per 7 h; P = 0·0001) ( 45 , 63 ) but no decrease in time spent in hypoglycemia was observed.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Collective Evidences Investigating the Effect of Diabetes Monitoring Systems and Their Application in Health Care

et al. 2021

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IntroductionDiabetes monitoring systems (DMS) are a possible approach for regular control of glucose levels in patients with Type 1 or 2 diabetes in order to improve therapeutic outcomes or to identify and modify inappropriate patient behaviors in a timely manner. Despite the significant number of studies observing the DMS, no collective evidence is available about the effect of all devices.GoalTo review and consolidate evidences from multiple systematic reviews on the diabetes monitoring systems and the outcomes achieved.Materials and methodsInternet-based search in PubMed, EMBASE, and Cochrane was performed to identify all studies relevant to the research question. The data regarding type of intervention, type of diabetes mellitus, type of study, change in clinical parameter(s), or another relevant outcome were extracted and summarized.ResultsThirty-three out of 1,495 initially identified studies, involving more than 44,100 patients with Type 1, Type 2, or gestational diabetes for real-time or retrospective Continuous Glucose Monitoring (CGMS), Sensor Augmented Pump Therapy (SAPT), Self-monitoring Blood Glucose (SMBG), Continuous subcutaneous insulin infusion (CSII), Flash Glucose Monitoring (FGM), Closed-loop systems and telemonitoring, were included. Most of the studies observed small nominal effectiveness of DMS. In total 11 systematic reviews and 15 meta-analyses, with most focusing on patients with Type 1 diabetes (10 and 6, respectively), reported a reduction in glycated hemoglobin (HbA1c) levels from 0.17 to 0.70% after use of DMS.ConclusionCurrent systematic review of already published systematic reviews and meta-analyses suggests that no statistically significant difference exists between the values of HbA1c as a result of application of any type of DMS. The changes in HbA1c values, number and frequency of hypoglycemic episodes, and time in glucose range are the most valuable for assessing the appropriateness and effectiveness of DMS. Future more comprehensive studies assessing the effectiveness, cost-effectiveness, and comparative effectiveness of DMS are needed to stratify them for the most suitable diabetes patients’ subgroups.

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“…The present results underscore the importance of management strategies that are tailored for avoidance of hypoglycaemic episodes rather than simply pursuing tight glycaemic targets in this vulnerable group. This is of particular significance in light of recent findings that asymptomatic hypoglyceamic episodes are often missed in older individuals with diabetes, as this study may be looking at only the tip of the iceberg regarding the impact of hypoglycaemia.…”

Section: Discussionmentioning

confidence: 99%

The effects of hypoglycaemia and dementia on cardiovascular events, falls and fractures and all‐cause mortality in older individuals: A retrospective cohort study

Mattishent

Richardson

Dhatariya

et al. 2019

Diabetes Obesity Metabolism

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Aims: Older individuals with diabetes are susceptible to harm as the result of hypoglycaemia; however, the consequences of hypoglycaemia in older individuals with dementia are not known. We aimed to test the association between hypoglycaemia and serious adverse events in older patients with diabetes and dementia, and whether the consequences of hypoglycaemia were affected by the presence of dementia. Materials and methods: This was a cohort study using the Clinical Practice ResearchDatalink in England (1997England ( -2016. We selected participants, intervention (exposure) and follow-up to mirror two hypothetical target randomized controlled trials. The exposure of target trial 1 was hypoglycaemia in patients with dementia. Target trial 2 examined adverse effects of hypoglycaemia according to dementia status. We used Cox proportional hazard regression to estimate adjusted hazard ratios (aHR) for falls, fractures, cardiovascular events and mortality.Results: In target trial 1, hypoglycaemia was associated with increased risk during a 12-month follow-up period for falls and fractures (aHR, 1.94 [95% CI, 1.67-2.24]), for cardiovascular events (aHR, 2.00 [95% CI, 1.61-2.48]) and for mortality (aHR, 2.36 [95% CI, 2.09-2.67]). In target trial 2, the presence of dementia was associated with increased risk of adverse events, following hypoglycaemia, during a 12-month follow-up period for falls and factures (aHR, 1.72 [95% CI, 1.51-1.96]) and for mortality (aHR, 1.27 [95% CI, 1.15-1.41]), but dementia had no effect on cardiovascular events (aHR, 1.14 [95% CI, 0.95 to 1.36]). Conclusions: Hypoglycaemia is associated with early increased risk of serious adverse events in older individuals with diabetes and dementia. K E Y W O R D S cohort study, diabetes complications, hypoglycaemia, observational study, type 1 diabetes, type 2 diabetes

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Detection of asymptomatic drug-induced hypoglycemia using continuous glucose monitoring in older people – Systematic review

Abstract: CGM frequently picks up asymptomatic hypoglycemic episodes in older patients with diabetes. Users of CGM report improved well-being, and reduction of diabetes-related stress.

Cited by 24 publications

References 19 publications

Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents

Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents

A Systematic Review of Collective Evidences Investigating the Effect of Diabetes Monitoring Systems and Their Application in Health Care

The effects of hypoglycaemia and dementia on cardiovascular events, falls and fractures and all‐cause mortality in older individuals: A retrospective cohort study

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