Blood sugar levels of older adults with type 1 diabetes (T1D) are in the hypoglycemic range for more than an hour a day, and blood sugar levels of those with impaired hypoglycemia awareness are in the hypoglycemic range for >100 minutes/day, according to an abstract presented at the Endocrine Society’s Annual Meeting, ENDO 2019, held March 23-26, in New Orleans, Louisiana.1

In the Wireless Innovations for Seniors with Diabetes Mellitus study conducted at 22 sites in the United States (ClinicalTrials.gov identifier: NCT03240432), researchers analyzed data from 203 older adults with T1D to evaluate the effect of continuous glucose monitoring (CGM) on hypoglycemia. All participants were ≥60 years old, had not used a real-time CGM in the 3 months prior to enrollment, and had a hemoglobin A1c level <10%. A blinded Dexcom G4 CGM was worn by participants at baseline for up to 21 days to collect at least 240 hours of CGM data.

Of the 203 participants, 52% were women, 93% were non-Hispanic white, and 53% used insulin pumps. The median age was 68 years and the mean hemoglobin A1c level was 7.5%. Overall, participants spent 5% and 1.6% of time with glucose levels <70 mg/dL and <54 mg/dL, respectively, equaling 72 and 24 minutes/day.

Impaired awareness of hypoglycemia was associated with greater time spent with glucose levels <70 mg/dL and <54 mg/dL. Compared with participants who were aware or uncertain, those with reduced hypoglycemia awareness spent more time with glucose levels <70 mg/dL (7% vs 5%; 101 vs 72 minutes/day; P =.01) and <54 mg/dL (3% vs 1%; 43 vs 14 minutes/day; P =.008).

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Participants spent a mean 56% of time in the target glucose range of 70 to 180 mg/dL (13.4 hours/day), a median 35% of time >180 mg/dL (8.4 hours/day), and a median 12% of time >250 mg/dL (2.8 hours/day).

Lower daily insulin level/kilogram was associated with having a higher percentage of glucose levels in range 70 to 180 mg/dL (P =.02) and a lower percentage of glucose levels >180 mg/dL (P =.04) and >250 mg/dL (P =.008).

Retired individuals spent more time in the target glucose range (P =.003) and less time with levels >180 mg/dL (P =.02) and >250 mg/dL (P <.001) compared with people who were either employed or unemployed.

“The findings underscore the need for interventions to help reduce the risk [for] severe hypoglycemia in this age group,” said lead researcher Anders L. Carlson, MD, medical director of the International Diabetes Center in Minneapolis, Minnesota, in a press release.2

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References

1. Carlson AL, Kanapka L, Miller K, et al. Exposure to hypoglycemia in older adults with type 1 diabetes: baseline characteristics using continuous glucose monitoring data. Presented at: ENDO 2019; March 23-26, 2019; New Orleans, LA. Abstract OR22-2.

2. Older adults with type 1 diabetes often not aware of hypoglycemia [press release]. Washington, DC: Endocrine Society; March 25, 2019. Accessed March 25, 2019.