Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes

Abstract

Background Little is known about the prevalence of hypoglycaemia in older people with diabetes. However, the HbA1c goal is ≥8% for institutionalised patients with treatments that can cause hypoglycaemia. Purpose We aimed to assess the prevalence of hypoglycaemia with continuous glucose monitoring and to evaluate the link with HbA1C in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs. Design Prospective, multicentre study carried out in six geriatric care centres in the Côte d’Or region of France between January 2019 and July 2020. Settings, subjects and methods A FreeStyle Libre Pro® (FSLP) was worn for up to 14 days in blinded mode in 42 patients taking at least one potentially hypoglycaemia-inducing antidiabetic drug. Results Two hundred and forty-two hypoglycaemic events were detected in 79% (n = 33) of patients wearing the FSLP. One or more hypoglycaemic event was detected in 100% of patients with HbA1C < 7% and in 79% of patients with HbA1C ≥ 8% (P = 0.02). The time spent in hypoglycaemia was higher in patients with HbA1C < 7% than those with HbA1C ≥ 8% (P = 0.015). Time spent <54 mg/dl was detected in 45% of patients. Conclusions We report a very high prevalence of hypoglycaemia, with a significant proportion of severe hypoglycaemia, in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs. Having HbA1C < 7% exposes patients to a higher risk of hypoglycaemia, but this risk remains also high in patients with HbA1C ≥ 8%. In this population, continuous glucose monitoring could be considered an effective tool to detect hypoglycemia, which is associated with increased risk of cardiovascular events, falling, fractures, cognitive impairment and mortality.

Assessment of the FreeStyle Libre 2 interstitial glucose monitor in hypo‐ and euglycemic cats

“…They allow for evaluation of glucose trends over time while decreasing overall cost of care and blood sampling‐associated patient discomfort 1 . Their use improves detection of hypoglycemia in human 2 and veterinary patients, providing a means to ameliorate primary stressors reported by owners 3,4 . The first generation of the FreeStyle Libre monitor (FSL1; Abbott Laboratories) has been validated for use in veterinary patients in both the inpatient and outpatient setting 5‐11 …”

Recent Trends in Diabetes Treatment and Control in US Adults: A Geriatrician’s Point of View

“…14 On the other hand, a growing number of studies show that an increase of inappropriate treatment intensification-reaching HbA 1c levels that are way below the recommended targets-is associated with adverse consequences in diabetic patients particularly in those aged more than 65 years. [5][6][7] These seemingly contradictory findings highlight the importance of a personalized and thoughtful approach to the management of diabetes and its risk factors. As an example, an increase in the use of newer and safer glucose lowering drugs (eg, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and dipeptidyl peptidase 4 inhibitors) can help achieve better HbA 1c goals with a reduced risk of hypoglycemic episodes as recently shown by a Danish study.…”

“…However, the risk of hypoglycemia or severe hypoglycemia remains high in older adults living in nursing facilities, even in those with an elevated HbA 1c of greater than 8%. 7 Moreover, in light of more relaxed HbA 1c treatment goals for older frail adults as recommended by international guidelines since 2010, 10,11 recent findings from the French GERODIAB cohort show an increased mortality (hazard ratio, 1.76) in type 2 diabetics aged 70 years and older with HbA 1c greater than or equal to 8.6%. 12 Similarly, a 5-year retrospective British study from 2018 which included patients aged 70 years and older, shows an increased overall mortality in those with HbA 1c greater than 8.5%.…”

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

“…Although the detection and prevention of hypoglycemia is a priority issue for patients with diabetes, there is still a lack of real‐life data regarding the frequency and predictive factors of hypoglycemia in older patients with T2D on insulin therapy. Frequency and risk factors for hypoglycemia were identified in studies that included either inpatients or outpatients able to monitor blood glucose 9–12 . Reliability of self‐reported measures of hypoglycemia is contingent on patients' hypoglycemia awareness and willingness to report hypoglycemic events.…”