CGM shows hypoglycemia common in older adults with type 1 diabetes
NEW ORLEANS — Older adults with type 1 diabetes spent more than an hour per day on average with blood glucose levels in the hypoglycemic range and more than 20 minutes per day with levels less than 54 mg/dL, according to data presented at The Endocrine Society Annual Meeting.
“Adults aged 60 years and older with type 1 diabetes spend a considerable amount of time with hypoglycemia ... which is dangerous in a population where severe hypoglycemia can have considerable consequences,” Anders L. Carlson, MD, medical director of the International Diabetes Center at Park Nicollet, director of the HealthPartners Diabetes Program, and an assistant professor in the University of Minnesota Medical School in Minneapolis, told Endocrine Today. “Those with impaired awareness of hypoglycemia are at twice as much risk for a very low glucose.”
Carlson presented data from the baseline period of the randomized controlled trial Wireless Innovations for Seniors with Diabetes Mellitus (WISDM), a study exploring whether continuous glucose monitoring use can help older adults with type 1 diabetes reduce duration and severity of hypoglycemia. Participants included 203 adults (median age, 68 years; 52% women; 93% non-Hispanic white) with type 1 diabetes and HbA1c less than 10% who had not used real-time CGM during the 3 months before enrollment; 53% of the cohort used an insulin pump. During the baseline period, participants wore a blinded Dexcom G4 CGM to collect at least 240 hours of data (up to 21 days). Researchers also collected demographic information for participants.
Among the cohort, median time spent with glucose level less than 70 mg/dL was 72 minutes per day and 24 minutes less than 54 mg/dL. Those with hypoglycemia unawareness had blood glucose levels less than 54 mg/dL for a median 2.7% of the day vs. 1.3% for those who recognized hypoglycemia or were unsure (P = .03).
Hyperglycemia with glucose more than 180 mg/dL was present for a median 8.4 hours per day and 2.8 hours above 250 mg/dL. More than half the time — 56% of the day — participants had blood glucose levels in the target range of 70 mg/dL to 180 mg/dL.
Time spent in target range and less time spent with hyperglycemia were associated with lower daily insulin dose (70-180 mg/dL, P = .02; 180 mg/dL, P = .04; 250 mg/dL, P = .008) and with being employed or unemployed vs. retired (70-180 mg/dL, P = .003; 180 mg/dL, P = .02; 250 mg/dL, P .001).
“CGM metrics, such as time in hypoglycemia and time in target range, may be a useful tool to help older adults living with type 1 diabetes take realtime actions to avoid, or at least minimize, hypoglycemia,” Carlson said. “Further, retrospective analysis of CGM metrics in this population, a group that has largely been excluded from technology studies, can be deployed successfully and used in a much more sophisticated way than reliance on HbA1c.” by Jill Rollet
Carlson AL, et al. OR22-2. Exposure to hypoglycemia in older adults with type 1 diabetes: Baseline characteristics using continuous glucose monitoring data. Presented at: The Endocrine Society Annual Meeting; March 23-26, 2019; New Orleans.
Disclosure: Carlson reports no relevant financial disclosures.