December 03, 2019
2 min read

Hypoglycemia increases frailty, mortality risks among adults with diabetes

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Adults with diabetes may have higher mortality rates and be more likely to have incident frailty if they experience at least one hypoglycemic episode, according to findings published in the Journal of Diabetes and its Complications.

“A comprehensive evaluation of the risk factor list for hypoglycemia can improve glycemic control and facilitate the selection of optimal antidiabetic medications, although subclinical hypoglycemic episodes are still common,” Kuo-Liong Chien, MD, PhD, of the department of epidemiology and preventive medicine in the College of Public Health of National Taiwan University, and colleagues wrote. “In this sense, understanding the entire spectrum of adverse influences arising from hypoglycemia shares the same degree of importance as risk factor management for clinicians taking caring of patients with diabetes.”

Chien and colleagues assessed frailty and mortality among a group of 2,108 adults (mean age, 65.8 years; 53.3% women) who experienced an episode of hypoglycemia no more than 3 years after being diagnosed with diabetes and compared these outcomes with those of 8,432 propensity-matched adults (mean age, 65.9 years; 54% women) who had diabetes and no history of hypoglycemia.

The researchers assessed frailty by collecting data on instances of conditions associated with fatigue, resistance, ambulation, illness and loss of weight as part of the FRAIL scale. According to the researchers, meeting the criteria from two of the five categories included in the scale equated to “the development of frailty,” and meeting the criteria for three of the five categories equated to incident frailty.

There were 126 diagnoses of incident frailty among those with a history of hypoglycemia and 46 with no history of hypoglycemia. According to the researchers, frailty risk was 1.46 times greater among participants with a history of hypoglycemia vs. participants who did not have such a history (HR = 1.46; 95% CI, 1.03-2.08).

There were 920 deaths among those with a history of hypoglycemia and 448 deaths among those with no history of hypoglycemia. Mortality risk was 1.462 times greater among participants with vs. without a history of hypoglycemia (HR = 1.462; 95% CI, 1.3-1.65).

In addition, the researchers noted that “a higher frequency of hypoglycemia was paralleled by a rising risk of mortality and frailty during follow-up in the unadjusted model.”

“The relationship between hypoglycemia and frailty/mortality mostly exhibited a dose-responsive association, supporting the validity of our findings,” the researchers wrote. “This phenomenon we revealed extends the spectrum of adverse [sequelae] brought by hypoglycemia among patients with diabetes, and it will be interesting to speculate whether management and prevention of hypoglycemia may benefit those at a higher risk of developing frailty in this ever-increasing population.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.