title: Frequent hypoglycemia among elderly patients with poor glycemic control.
abstract: BACKGROUND
  Episodes of hypoglycemia are particularly dangerous in the older population. To reduce the risk of hypoglycemia, relaxation of the standard hemoglobin A(1c) (HbA(1c)) goals has been proposed for frail elderly patients. However, the risk of hypoglycemia in this population with higher HbA(1c) levels is unknown.
  
  
  METHODS
  Patients 69 years or older with HbA(1C) values of 8% or greater were evaluated with blinded continuous glucose monitoring for 3 days.
  
  
  RESULTS
  Forty adults (mean [SD] age, 75 [5] years; HbA(1C) 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 HbA(1C) goals may not be adequate to prevent hypoglycemia in this population.
authors.affiliation: Sections of Adult Diabetes, Joslin Diabetes Center, Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. medha.munshi@joslin.harvard.edu
authors.forename: Medha N
authors.initials: MN
authors.lastname: Munshi
authors.forename: Alissa R
authors.initials: AR
authors.lastname: Segal
authors.forename: Emmy
authors.initials: E
authors.lastname: Suhl
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Staum
authors.forename: Laura
authors.initials: L
authors.lastname: Desrochers
authors.forename: Adrianne
authors.initials: A
authors.lastname: Sternthal
authors.forename: Judy
authors.initials: J
authors.lastname: Giusti
authors.forename: Richard
authors.initials: R
authors.lastname: McCartney
authors.forename: Yishan
authors.initials: Y
authors.lastname: Lee
authors.forename: Patricia
authors.initials: P
authors.lastname: Bonsignore
authors.forename: Katie
authors.initials: K
authors.lastname: Weinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000628:therapy; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000517:prevention & control*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin