Nocturnal hypoglycemia underdiagnosed in older patients on insulin for type 2 diabetes
An industry-funded study of patients age 75 years and older who were taking insulin for type 2 diabetes found that almost two-thirds (65.2%) experienced nocturnal hypoglycemia during a 28-day study period.
Nocturnal hypoglycemia is common and underdiagnosed in older patients with insulin-treated type 2 diabetes, an industry-funded study found.
To determine the frequency and predictors of hypoglycemia in patients age 75 years and older who were taking insulin for type 2 diabetes, researchers conducted a prospective multicenter study of 141 patients who self-monitored their blood glucose levels twice or more a day. Participants underwent a geriatric and diabetic assessment and received ambulatory blinded continuous glucose monitoring (CGM) for 28 consecutive days.
Researchers examined factors associated with hypoglycemia confirmed via self-monitoring (<70 mg/dL [<3.9 mmol/L]) and with a nocturnal glucose level two times below range (<54 mg/dL [<3.0 mmol/L] during ≥15 consecutive minutes between midnight and 6 a.m.). The trial was funded by Sanofi. Results were published March 25 by the Journal of the American Geriatrics Society.
The patients' mean baseline level HbA1c was 7.9%±1.0%. Based on geriatric assessment, 72.3% were considered complex and 27.7% were considered healthy. Less than half of the patients (37.6%) reported a self-monitored blood glucose measurement below 70 mg/dL (3.9 mmol/L). Risk of hypoglycemia was associated with a longer duration of diabetes (odds ratio [OR] for each year, 1.04 [95% CI, 1.00 to 1.08]; P=0.04) and glycemic variability (OR with a 1% increase, 1.12 [95% CI, 1.05 to 1.19]; P<0.001). In contrast, almost two-thirds of patients (65.2%) experienced nocturnal hypoglycemia. Cognitive impairment (OR, 9.31; 95% CI, 2.59 to 33.4), heart failure (OR, 4.81; 95% CI, 1.48 to 15.6), and depressive disorder (OR, 0.19; 95% CI, 0.06 to 0.53) were associated with nocturnal hypoglycemia.
The study authors suggested that CGM could be a promising tool to better identify hypoglycemia and adapt diabetes management in this population, because hypoglycemia episodes are associated with reduced quality of life and long-term complications.
“Nocturnal hypoglycemias are frequent and rarely diagnosed by self-monitoring of capillary glucose tests because many of these episodes do not waken the person who is affected,” the authors wrote. “In contrast to HbA1C, the use of CGM is a powerful tool to detect a nocturnal time in hypoglycemia and to personalize patients' management especially for those with cognitive impairment.”