Hypoglycemia Unawareness in Older Compared With Middle-Aged Patients With Type 2 Diabetes

Abstract

OBJECTIVEOlder patients with type 2 diabetes are at a particularly high risk for severe hypoglycemic episodes, and experimental studies in healthy subjects hint at a reduced awareness of hypoglycemia in aged humans. However, subjective responses to hypoglycemia have rarely been assessed in older type 2 diabetic patients.RESEARCH DESIGN AND METHODSWe tested hormonal, subjective, and cognitive responses (reaction time) to 30-min steady-state hypoglycemia at a level of 2.8 mmol/l in 13 older (≥65 years) and 13 middle-aged (39–64 years) type 2 diabetic patients.RESULTSHormonal counterregulatory responses to hypoglycemia did not differ between older and middle-aged patients. In contrast, middle-aged patients showed a pronounced increase in autonomic and neuroglycopenic symptom scores at the end of the hypoglycemic plateau that was not observed in older patients (both P < 0.01). Also, seven middle-aged patients, but only one older participant, correctly estimated their blood glucose concentration to be <3.3 mmol/l during hypoglycemia (P = 0.011). A profound prolongation of reaction times induced by hypoglycemia in both groups persisted even after 30 min of subsequent euglycemia.CONCLUSIONSOur data indicate marked subjective unawareness of hypoglycemia in older type 2 diabetic patients that does not depend on altered neuroendocrine counterregulation and may contribute to the increased probability of severe hypoglycemia frequently reported in these patients. The joint occurrence of hypoglycemia unawareness and deteriorated cognitive function is a critical factor to be carefully considered in the treatment of older patients.

Hipoglicemia recurrente como causa reversible de síndrome demencial en adultos mayores diabéticos, a propósito de un caso

“…Estas observaciones, sumadas a los recientes reportes de aumento en la mortalidad de diabéti-cos tipo 2 manejados bajo esquemas terapéuticos orientados al logro de niveles de Hb glicosilada A1C < 6% 17 , sugieren considerar una mayor flexibilidad en las metas de control metabólico, especialmente en el subgrupo de adultos mayores 18 .…”

Severe hypoglycaemia in elderly patients with type 2 diabetes and coexistence of cardiovascular history

“…The significant number of cases of hypoglycaemia results from the unnecessary use of drugs associated with an increased risk of hypoglycaemia, especially in old patients with advanced co-morbidities [18]. Moreover, a combination of cognitive dysfunction and hypoglycaemic unawareness, which is clearly noticed more frequently in the elderly, is a critical factor in the treatment of this age group [19].…”

IDegAsp (insulin degludec + insulin aspart) for the management of type 2 diabetes: current status

“…Reduced hypoglycemia might also be expected to improve adherence to the IDegAsp insulin regimen [26], although (as yet) no data have been found that are related to fear of hypoglycemia or health-related quality of life. Reduction in nocturnal hypoglycemia can also be expected to reduce the problem of hypoglycemia awareness, something that becomes more common in middle and later age [57] but, again, no data are yet available on this issue for IDegAsp.…”