title: Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 Diabetes.
abstract: Severe hypoglycemia is common in older adults with long-standing type 1 diabetes, but little is known about factors associated with its occurrence.
  
  
  
  A case-control study was conducted at 18 diabetes centers in the T1D Exchange Clinic Network. Participants were ≥60 years old with type 1 diabetes for ≥20 years. Case subjects (n = 101) had at least one severe hypoglycemic event in the prior 12 months. Control subjects (n = 100), frequency-matched to case subjects by age, had no severe hypoglycemia in the prior 3 years. Data were analyzed for cognitive and functional abilities, social support, depression, hypoglycemia unawareness, various aspects of diabetes management, C-peptide level, glycated hemoglobin level, and blinded continuous glucose monitoring (CGM) metrics.
  
  
  
  Glycated hemoglobin (mean 7.8% vs. 7.7%) and CGM-measured mean glucose (175 vs. 175 mg/dL) were similar between case and control subjects. More case than control subjects had hypoglycemia unawareness: only 11% of case subjects compared with 43% of control subjects reported always having symptoms associated with low blood glucose levels (P < 0.001). Case subjects had greater glucose variability than control subjects (P = 0.008) and experienced CGM glucose levels <60 mg/dL for ≥20 min on 46% of days compared with 33% of days in control subjects (P = 0.10). On certain cognitive tests, case subjects scored worse than control subjects.
  
  
  
  In older adults with long-standing type 1 diabetes, greater hypoglycemia unawareness and glucose variability are associated with an increased risk of severe hypoglycemia. A study to assess interventions to prevent severe hypoglycemia in high-risk individuals is needed.
authors.affiliation: State University of New York Upstate Medical University, Syracuse, NY.
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: DuBose
authors.affiliation: Park Nicollet International Diabetes Center, Minneapolis, MN.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Bergenstal
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Chaytor
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: Christina
authors.initials: C
authors.lastname: Peterson
authors.affiliation: Park Nicollet International Diabetes Center, Minneapolis, MN.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Olson
authors.affiliation: Joslin Diabetes Center/Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Medha N
authors.initials: MN
authors.lastname: Munshi
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Alysa J S
authors.initials: AJ
authors.lastname: Perrin
authors.affiliation: Jaeb Center for Health Research, Tampa, FL t1dstats@jaeb.org.
authors.forename: Kellee M
authors.initials: KM
authors.lastname: Miller
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.affiliation: Rocky Mountain Diabetes and Osteoporosis Center, Idaho Falls, ID.
authors.forename: David R
authors.initials: DR
authors.lastname: Liljenquist
authors.affiliation: Northwestern University, Chicago, IL.
authors.forename: Grazia
authors.initials: G
authors.lastname: Aleppo
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: John B
authors.initials: JB
authors.lastname: Buse
authors.affiliation: Henry Ford Medical Center, Detroit, MI.
authors.forename: Davida
authors.initials: D
authors.lastname: Kruger
authors.affiliation: Iowa Diabetes and Endocrinology Research Center, Des Moines, IA.
authors.forename: Anuj
authors.initials: A
authors.lastname: Bhargava
authors.affiliation: Naomi Berrie Diabetes Center at Columbia University Medical Center, New York, NY.
authors.forename: Robin S
authors.initials: RS
authors.lastname: Goland
authors.affiliation: Regional Health Clinical Research, Rapid City, SD.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Edelen
authors.affiliation: Florida Hospital Diabetes and Translational Research Institute for Metabolism and Diabetes, Orlando, FL.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Pratley
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: University of South Florida, Tampa, FL.
authors.forename: Henry
authors.initials: H
authors.lastname: Rodriguez
authors.affiliation: Oregon Health and Science University, Portland, OR.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Ahmann
authors.affiliation: University of Massachusetts Memorial Medical Center, Worcester, MA.
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Lock
authors.affiliation: Barbara Davis Center for Childhood Diabetes, Aurora, CO.
authors.forename: Satish K
authors.initials: SK
authors.lastname: Garg
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Rickels
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: Irl B
authors.initials: IB
authors.lastname: Hirsch
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000150:complications; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents