title: Hypoglycemia in Older Adults with Type 1 Diabetes.
abstract: Hypoglycemia is a major concern in older adults with type 1 diabetes (T1D) and there is limited knowledge in this population. We examined data from 199 adults, ≥60 years of age, who participated in a T1D Exchange study assessing factors associated with severe hypoglycemia (SH) in older adults with T1D: 100 with SH in the prior year and 99 with no SH in prior 3 years (mean age 68; mean diabetes duration 40 years; 47% female; 92% non-Hispanic white). Hypoglycemia was assessed with up to 14 days of blinded continuous glucose monitoring (CGM). Linear regression models were performed to assess the association between biochemical hypoglycemia [defined as percentage of time below specific cutoffs (<70/60/50 mg/dL)] and various factors.
  
  
  
  Overall, participants had CGM values <70 mg/dL for a median of 91 min per day. On 53% of days, glucose levels continuously were <70 mg/dL for ≥20 min. Hypoglycemia was found to be strongly associated with glucose variability (r = 0.76; P < 0.001). Time spent in hypoglycemia was greater in those who were younger (P = 0.004), had shorter diabetes duration (P = 0.008), lower HbA1c (P < 0.001), and undetectable C-peptide (P = 0.001), but did not differ by insulin method, education level, number of blood glucose checks per day, cognition, activities of daily living, or fear of hypoglycemia.
  
  
  
  This study adds valuable data on the frequency of hypoglycemia in older adults with T1D.
  
  
  
  Future studies need to focus on how to prevent hypoglycemia in this vulnerable population of older adults with long-standing T1D.
authors.affiliation: 1 Jaeb Center for Health Research , Tampa, Florida.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: DuBose
authors.affiliation: 2 State University of New York Upstate Medical University , Syracuse, New York.
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
authors.affiliation: 1 Jaeb Center for Health Research , Tampa, Florida.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.affiliation: 3 Keck School of Medicine of the University of Southern California , Los Angeles, California.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: 4 Northwestern University , Chicago, Illinois.
authors.forename: Grazia
authors.initials: G
authors.lastname: Aleppo
authors.affiliation: 5 International Diabetes Center Park Nicollet , Minneapolis, Minnesota.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Bergenstal
authors.affiliation: 6 University of South Florida , Tampa, Florida.
authors.forename: Henry
authors.initials: H
authors.lastname: Rodriguez
authors.affiliation: 7 University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Largay
authors.affiliation: 4 Northwestern University , Chicago, Illinois.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Massaro
authors.affiliation: 8 University of Washington , Seattle, Washington.
authors.forename: Irl B
authors.initials: IB
authors.lastname: Hirsch
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D007003:Hypoglycemia; D008297:Male; D008875:Middle Aged
keywords: Diabetes management; Hypoglycemia; Older adults; Type 1 diabetes