Title :

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

Author(s) :

Boureau, Anne‐sophie [Auteur]
Pôle hospitalo-universitaire de gérontologie clinique [Nantes]
Guyomarc'H-Delasalle, Béatrice [Auteur]
ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291 [ITX-lab]
Gourdy, Pierre [Auteur]
Centre Hospitalier Universitaire de Toulouse [CHU Toulouse]
Institut des Maladies Métaboliques et Casdiovasculaires [UPS/Inserm U1297 - I2MC]
Allix, Ingrid [Auteur]
Centre Hospitalier Universitaire d'Angers [CHU Angers]
Annweiler, Cédric [Auteur]
Laboratoire de Psychologie des Pays de la Loire [LPPL]
Cervantes, Nathalie [Auteur]
Centre Hospitalier Sud Francilien
Chapelet, Guillaume [Auteur]
Pôle hospitalo-universitaire de gérontologie clinique [Nantes]
Delabrière, Isabelle [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Guyonnet, Sophie [Auteur]
Equipe Vieillissement (CERPOP)
Litke, Rachel [Auteur]
Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 [RID-AGE]
Paccalin, Marc [Auteur]
CIC Poitiers – Centre d'investigation clinique de Poitiers [CIC 1402]
Penfornis, Alfred [Auteur]
Centre Hospitalier Sud Francilien
Saulnier, Pierre-Jean [Auteur]
CIC Poitiers – Centre d'investigation clinique de Poitiers [CIC 1402]
Wargny, Matthieu [Auteur]
ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291 [ITX-lab]
Hadjadj, Samy [Auteur]
ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291 [ITX-lab]
de Decker, Laure [Auteur]
Pôle hospitalo-universitaire de gérontologie clinique [Nantes]
Cariou, Bertrand [Auteur]
ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291 [ITX-lab]

Journal title :

Journal of the American Geriatrics Society

Pages :

2107 - 2119

Publisher :

Wiley

Publication date :

2023-03-25

ISSN :

0002-8614

English keyword(s) :

basal insulin analogues
continuous glucose monitoring
glycemic control
hypoglycemia
older patients
type 2 diabetes

HAL domain(s) :

Sciences de l'Homme et Société/Psychologie

English abstract : [en]

<b>Background :</b> There is a lack of real‐life data regarding the frequency and predictive factors of hypoglycemia in older patients with type 2 diabetes (T2D). This study aimed to determine the frequency and predictors ...
Show more ><b>Background :</b> There is a lack of real‐life data regarding the frequency and predictive factors of hypoglycemia in older patients with type 2 diabetes (T2D). This study aimed to determine the frequency and predictors of hypoglycemia in older patients with insulin‐treated T2D.<br/><b>Methods :</b> This prospective multicenter study included 155 insulin‐treated T2D patients aged 75 years and older with ≥2 self‐monitoring of blood glucose (SMBG) daily controls. Participants underwent a geriatric and diabetic assessment and received ambulatory blinded continuous glucose monitoring (CGM) for 28 consecutive days with FreeStyle Libre Pro® sensor. Study population ( n = 141) has >70% CGM active time. Multivariable logistic regressions were used to identify factors associated with SMBG confirmed hypoglycemia (≥70 mg/dL) and with nocturnal level 2 time below range (glucose concentration <54 mg/dL during ≥15 consecutive min between 0.00 and 6.00 am).<br/><b>Results :</b> The mean age of the 141 analyzed patients was 81.5 ± 5.3 years and 56.7% were male. The mean baseline HbA 1c was 7.9% ± 1.0%. After geriatric assessment, 102 participants (72.3%) were considered as complex and 39 (27.7%) as healthy. The primary endpoint (confirmed SMBG <70 mg/dL) occurred in 37.6% patients. In multivariable analysis, the risk of SMBG‐confirmed hypoglycemia was positively associated with a longer duration of diabetes (OR (+1 year) =1.04, (1.00–1.08), p = 0.04) and glycemic variability assessed by CGM (CV %) (OR (+1%) = 1.12, [1.05–1.19], p = <0.001). Nighty‐two patients (65.2%) experienced nocturnal time in hypoglycemia (i.e., <54 mg/dL during ≥15 consecutive min between midnight and 6 a.m.). In multivariable analyses, cognitive impairment (OR: 9.31 [2.59–33.4]), heart failure (OR: 4.81 [1;48–15.6]), and depressive disorder (OR: 0.19 [0.06–0.53]) were associated with nocturnal time in hypoglycemia.<br/><b>Conclusion :</b> Nocturnal hypoglycemia is very common and largely underdiagnosed in older patients with insulin‐treated T2D. CGM is a promising tool to better identify hypoglycemia and adapt diabetes management in this population.Show less >

Language :

Anglais

Peer reviewed article :

Oui

Audience :

Internationale

Popular science :

Non

Collections :

• Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement (RID-AGE) - U1167

Source :

Harvested from HAL