title: Hypoglycemia Incidence in Older Adults by Estimated GFR.
abstract: BACKGROUND
  Bedside estimates of the risk for hypoglycemia by estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (ACR), and use of antihyperglycemic medications would be helpful.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Older adults (mean age, 75 years) in Ontario, Canada, from April 2002 through March 2013.
  
  
  METHODS
  eGFR stage, ACR stage, and use of antihyperglycemic medications.
  
  
  RESULTS
  3-year incidence rate of a hospital encounter with hypoglycemia (emergency department or inpatient encounter).
  
  
  RESULTS
  In users and nonusers of antihyperglycemic medications, there was a graded increase in risk for hypoglycemia by eGFR stage. Incidence rates in antihyperglycemic medication users were 82 (95% CI, 71-94), 122 (95% CI, 115-130), 235 (95% CI, 218-254), 379 (95% CI, 349-413), 596 (95% CI, 524-678), and 785 (95% CI, 689-894) encounters per 10,000 person-years when eGFR was ≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, and <15mL/min/1.73m2or the patient was receiving dialysis, respectively (P<0.001). Corresponding values in nonusers were 2 (95% CI, 2-4), 3 (95% CI, 3-4), 3 (95% CI, 2-4), 7 (95% CI, 5-9), 14 (95% CI, 9-22), and 55 (95% CI, 43-71) encounters/10,000 person-years, respectively (P<0.001). A similar relationship was evident by eGFR and ACR risk category.
  
  
  CONCLUSIONS
  Only hypoglycemia episodes that were associated with a hospital encounter were assessed. Results cannot be generalized to younger patients.
  
  
  CONCLUSIONS
  In older adults, the risk for hypoglycemia is higher in those with lower kidney function. Our results may aid the patient-provider dialogue and inform future studies to prevent hypoglycemia in an at-risk population.
authors.affiliation: School of Health Studies, Western University, London, Ontario, Canada.
authors.forename: Meryl
authors.initials: M
authors.lastname: Hodge
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: McArthur
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Division of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, Western University, London, Ontario, Canada. Electronic address: kristin.clemens@sjhc.london.on.ca.
authors.forename: Kristin K
authors.initials: KK
authors.lastname: Clemens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology* / Q000503:physiopathology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents
keywords: Hypoglycemia; antihyperglycemic medications; elderly; epidemiology; estimated glomerular filtration rate (eGFR); glycated hemoglobin (HbA(1c)); hospital encounter; kidney disease; older adults; outcomes; renal function; urinary albumin-creatinine ratio (UACR)