Survey of Hypoglycemia in Elderly People With Type 2 Diabetes Mellitus in Japan

Abstract

BackgroundThe number of elderly type 2 diabetes mellitus (T2DM) patients in Japan is increasing continuously. Hypoglycemia is a significant issue in their treatment. However, the actual situation and related details of their hypoglycemia remain unclear. In order to elucidate them, the Japan Physicians Association conducted a large-scale questionnaire survey for physicians and their outpatients all over Japan.MethodsTargeted elderly T2DM outpatients were 65 years old or older in 2011. Specialized questionnaire survey forms were distributed to both of physicians and patients. The forms for physicians included questions whether patient had hypoglycemia in the last 1 month or 1 year; those for patients included whether they experienced it in the same durations and any of the 28 symptoms that are suggestive of hypoglycemia or pertaining to geriatric syndrome in the last 1 month, as well as questions about knowledge regarding hypoglycemia. We analyzed associations between hypoglycemia and the symptoms, and between hypoglycemia and medications.ResultsOf 15,892 T2DM patients (age, 74.2 ± 6.3 years; diabetes duration, 12.8 ± 8.9 years; HbA1c, 7.0±1.0%), dipeptidyl peptidase-4 inhibitor (DPP-4i) was the most prescribed medication among all oral hypoglycemic agents (OHAs). The frequencies of hypoglycemia in the last 1 month recognized by physicians and experienced by patients were 7.8% and 10.4% (P < 0.0001), and in the last 1 year were 15.5% and 21.1% respectively (P < 0.0001). The most common symptom was “weakness, fatigue/feeling languid” and the majority of all patients reported neuroglycopenic or autonomic symptoms. Regarding monotherapy, hypoglycemia was observed in 32.7% of the patients with insulin, 4% in sulfonylurea (SU), 3.8% in glinide, and 3.5% in pioglitazone. The questions asking knowledge about hypoglycemia revealed that SU or insulin users had significantly more knowledge of hypoglycemia than others (P < 0.001); however, 63% of patients using insulin, and 31% of patients using SU always carried glucose or a similar medication with them.ConclusionsThe present study suggested two types of “hidden hypoglycemia”, one is that physicians did not detect and the other one is that patients were not aware. It is vital that physicians strive to prevent hypoglycemia by paying closer attention to symptoms of “hidden hypoglycemia” in their elderly patients.

Response: Patient Understanding of Hypoglycemia in Tertiary Referral Centers (Diabetes Metab J 2018;42:43-52)

“…Moreover, the educated group did not give better answers to certain questions compared to uneducated group. In a survey of hypoglycemia conducted in Japan, about 43% of the patients had knowledge about symptoms of hypoglycemia, 25% of the patients were aware of the cause of hypoglycemia, but only 19% of patients knew when hypoglycemia would occur [ 7 ]. In this study, patient's perception seemed to be overestimated because it was investigated by self-assessed knowledge of hypoglycemia.…”

Assessing hypoglycemia frequency using flash glucose monitoring in older Japanese patients with type 2 diabetes receiving oral hypoglycemic agents

“…Furthermore, a study on hypoglycemia in older Japanese individuals has reported that SU and glinides have a high odds ratio of causing hypoglycemia among the oral hypoglycemic agents. However, the hypoglycemia risk of glinides is reportedly significantly lower than that of SU . Several studies reported that repaglinide produces less hypoglycemia than SU .…”

“…However, the hypoglycemia risk of glinides is reportedly significantly lower than that of SU. 19 Several studies reported that repaglinide produces less hypoglycemia than SU. [20][21][22] Although considering the small number of patients using glinides in the present study, it would seem that at least for older individuals, glinides are more appropriately indicated compared with SU.…”

Risk of hypoglycaemia in people aged ≥65 years receiving linagliptin: pooled data from 1489 individuals with type 2 diabetes mellitus

“…The risk of moderate or severe hypoglycaemia in older individuals is associated with reduced satisfaction with, and adherence to, T2DM treatment, which could lead to suboptimal control of hyperglycaemia and an elevated risk of diabetes‐related complications. Furthermore, hypoglycaemia is associated with an increased risk of cognitive decline and dementia in older individuals, and as T2DM and cognitive decline progress, patients experience increased difficulties in promptly identifying the symptoms of hypoglycaemia, which compounds the problem . Given the risks associated with hypoglycaemia, including increased hip fracture incidence, poor treatment adherence, and accentuated cognitive decline, minimising the risk of hypoglycaemia is a key objective of T2DM therapeutic strategies in older patients …”

“…In a survey assessing the incidence of hypoglycaemia in older patients with T2DM in Japan, DPP‐4 inhibitors were the most frequently prescribed oral antidiabetes drugs and were associated with a low risk of hypoglycaemia . However, cases of severe hypoglycaemia when sitagliptin was used in combination with an SU were reported in Japan, after November 2009.…”