January 12, 2016
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Glycemic unawareness, variability lead to severe hypoglycemia among older adults with type 1 diabetes

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Older adults with long-standing type 1 diabetes are more likely to experience a severe hypoglycemic episode with greater hypoglycemia unawareness and glucose variability, according to study findings.

“Hypoglycemia unawareness, which is associated with altered counterregulation, is more common in older adults with long-duration [type 1 diabetes] than in younger individuals or those with type 2 diabetes,” the researchers wrote. “Individuals with reduced hypoglycemia awareness are more prone to severe hypoglycemia and high morbidity and mortality, particularly in the elderly.”

Ruth S. Weinstock, MD, PhD, of the State University of New York Upstate Medical Center in Syracuse, and colleagues evaluated data from adults aged at least 60 years with type 1 diabetes for 20 years or longer who experienced at least one severe hypoglycemic event in the past 12 months (cases; n = 101) and age-matched controls with no severe hypoglycemia in the past 3 years (n = 100). Participants were recruited from 18 diabetes centers in the T1D Exchange Clinic Network. Researchers sought to determine potential contributing factors to the occurrence of severe hypoglycemia.

Ruth Weinstock

Ruth S. Weinstock

Both groups had similar mean HbA1c and mean continuous glucose monitoring levels.

Significant hypoglycemia unawareness was reported by more cases compared with controls: 43% of controls reported having symptoms when blood glucose was low compared with 11% of cases (P < .001), and 6% of controls reported never or rarely having symptoms compared with 17% of cases (P = .04). Three percent of controls reported having no symptoms until blood glucose was lower than 40 mg/dL compared with 20% of cases (P = .009).

“Our results suggest that raising HbA1c goals in many patients will be insufficient to reduce severe hypoglycemia in this population due to the presence of hypoglycemia unawareness and increased glucose variability,” the researchers wrote. “Therefore, until an artificial pancreas or beta-cell replacement therapy becomes available, frequent home glucose measurements may be an important strategy for these patients. Other methods to reduce hypoglycemic exposure and minimize beta-blocker use should be considered. The use of current technologies, such as [continuous glucose monitoring] and threshold suspend pumps, in this population requires further study.” – by Amber Cox

Disclosure: Weinstock reports that her nonprofit employer is the site for multicenter clinical trials sponsored by AstraZeneca, Eli Lilly, GlaxoSmithKline, Johnson & Johnson and Medtronic. Please see the full study for a list of all other authors’ relevant financial disclosures.