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Clinical Observation
February 28, 2011

Frequent Hypoglycemia Among Elderly Patients With Poor Glycemic Control

Author Affiliations

Author Affiliations: Sections of Adult Diabetes (Drs Munshi and Segal and Ms Staum) and Clinical, Behavioral, and Outcome Research (Mss Suhl, Sternthal, Giusti, and Lee; Mr McCartney; and Dr Weinger), Joslin Diabetes Center, Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center (Dr Munshi), Harvard Medical School (Drs Munshi and Weinger), Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences (Dr Segal), and Department of Health Sciences, Northeastern University (Ms Desrochers), Boston; and Diabetes Program, Valley Medical Group, Amherst (Ms Bonsignore), Massachusetts.

Arch Intern Med. 2011;171(4):362-364. doi:10.1001/archinternmed.2010.539

Background  Episodes of hypoglycemia are particularly dangerous in the older population. To reduce the risk of hypoglycemia, relaxation of the standard hemoglobin A1c (HbA1c) goals has been proposed for frail elderly patients. However, the risk of hypoglycemia in this population with higher HbA1c levels is unknown.

Methods  Patients 69 years or older with HbA1C values of 8% or greater were evaluated with blinded continuous glucose monitoring for 3 days.

Results  Forty adults (mean [SD] age, 75 [5] years; HbA1C value, 9.3% [1.3%]; diabetes duration, 22 [14] years; 28 patients [70%] with type 2 diabetes mellitus; and 37 [93%] using insulin) were evaluated. Twenty-six patients (65%) experienced 1 or more episodes of hypoglycemia (glucose level <70 mg/dL). Among these, 12 (46%) experienced a glucose level below 50 mg/dL and 19 (73%), a level below 60 mg/dL. The average number of episodes was 4; average duration, 46 minutes. Eighteen patients (69%) had at least 1 nocturnal episode (10 PM to 6 AM). Of the total of 102 hypoglycemic episodes, 95 (93%) were unrecognized by finger-stick glucose measurements performed 4 times a day or by symptoms.

Conclusions  Hypoglycemic episodes are common in older adults with poor glycemic control. Raising HbA1C goals may not be adequate to prevent hypoglycemia in this population.