title: Continuous glucose monitoring reveals hypoglycemia risk in elderly patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  The incidence of type 2 diabetes is higher in elderly patients, in whom this disease is associated with dementia, falling, stroke and death. We utilized a continuous glucose monitoring device to analyze the relationship between hypoglycemia and diabetes treatments to identify risk factors for hypoglycemia (defined as a blood glucose level <70 mg/dL).
  
  
  METHODS
  We classified 170 patients aged ≥65 years with type 2 diabetes who were receiving steady-state medication (29 of whom were inpatients) into hypoglycemic and non-hypoglycemic groups, and compared their glycosylated hemoglobin levels, treatment types, continuous glucose monitoring data and other parameters. We carried out univariate analyses to identify variables associated with hypoglycemia risk, followed by multivariate analyses of drug class and other factors. The accuracy of the continuous glucose monitoring data was confirmed by calibration.
  
  
  RESULTS
  Hypoglycemia risk was higher in the patients using insulin (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.16-4.08, P = 0.015), and lower in patients who were being treated with dipeptidyl peptidase-4 inhibitors (OR 0.47, 95% CI: 0.25-0.89, P = 0.019). Patients with lower variability in blood glucose had a significantly lower hypoglycemia risk (OR 0.87, 95% CI: 0.83-0.91, P < 0.0001), and those with a lower average blood glucose level had a significantly higher risk (OR 1.09, 95% CI: 1.06-1.12, P < 0.0001).
  
  
  CONCLUSIONS
  In patients aged ≥65 years with type 2 diabetes, higher glucose variability and lower average glucose levels indicate a greater hypoglycemia risk. It is therefore necessary to ensure comprehensive blood glucose control in such patients to prevent hypoglycemia.
authors.affiliation: Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba City, Chiba, Japan.|Geriatric Medical Center, Chiba University Hospital, Chiba City, Chiba, Japan.|Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba City, Chiba, Japan.|Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
authors.forename: Masaya
authors.identifier: http://orcid.org/0000-0001-7374-9993
authors.initials: M
authors.lastname: Koshizaka
authors.affiliation: Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba City, Chiba, Japan.|Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Maezawa
authors.affiliation: Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba City, Chiba, Japan.|Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Takemoto
authors.affiliation: Kashiwado Hospital, Chiba City, Chiba, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tokuyama
authors.affiliation: Kashiwado Hospital, Chiba City, Chiba, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba City, Chiba, Japan.|Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
authors.forename: Koutaro
authors.initials: K
authors.lastname: Yokote
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008991:Monitoring, Physiologic; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Continuous glucose monitoring; Elderly patients; Hypoglycemia