Problem of hypoglycemia unawareness highlighted in older people with type 1 diabetes
medwireNews: Baseline data from the WISDM trial show that older adults with type 1 diabetes who have impaired awareness of hypoglycemia symptoms can spend over half an hour per day with extremely low blood glucose levels.
These study participants spent a median of 39 mins/day, or 2.7% of their time, with glucose levels at a “dangerously low” level of below 54 mg/dL (3.0 mmol/L), researcher Anders Carlson (International Diabetes Center, Minneapolis, Minnesota, USA) told the press at ENDO 2019 in New Orleans, Louisiana, USA.
This was more than double the time of people who said they were aware of their hypoglycemia symptoms, which was a median of 19 mins/day (1.3%). The participants overall spent a median of 72 minutes/day (5.0%) with a glucose level below 70 mg/dL (3.9 mmol/L).
The findings come from blinded continuous glucose monitoring (CGM) data, collected at baseline of the 6-month randomized WISDM trial, which recruited only people aged at least 60 years; the median was 68 years and the median diabetes duration was 36 years. The average glycated hemoglobin level of the 203 people enrolled was 7.5% and 53% of the participants were using an insulin pump.
Carlson also revealed that these older adults were not achieving the recommended time in target glucose range (TIR; 70–180 mg/dL), remaining within this range for a median of only 13.7 hours/day (57%). The time spent in hyperglycemia was 8.4 hours/day (35%) for glucose levels higher than 180 mg/dL (10 mmol/L) and 2.8 hours/day (12%) for levels higher than 250 mg/dL (14 mmol/L).
The researchers identified just three variables that were independently associated with TIR. Being retired and having a lower total daily insulin dose were associated with a higher TIR, and there was an “unexpected” U-shaped association for household income, with people at the lowest and highest ends of the income scale having the highest TIR.
“We still strongly feel that hypoglycemia is a major barrier to optimal glucose control in type 1 diabetes,” Carlson concluded, highlighting the role of symptom unawareness in the time spent at very low glucose levels.
He said that WISDM is testing the effect of 6 months of CGM use on glucose control in this age group, and the team expects to report the primary findings later this year.
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