High incidence of undetected low sensor glucose events among elderly patients with type 2 diabetes more than a decade on after the ACCORD study.

Objective

Hypoglycaemia leads to significant morbidity and impacts negatively on quality of life, especially in elderly people with increased frailty.The aims of this study were to determine the prevalence of low interstitial fluid glucose (IFG) in patients with tightly controlled type 2 diabetes (T2D), and to evaluate whether there were differences in burden of low IFG between sulphonylurea and insulin treated groups.

Methods

A Freestyle Libre-Pro sensor was used for sampling of the IFG continuously. Patients were blinded to the IFG levels. The sensor was returned to the investigators after a 2-week period and the data were downloaded for analysis.

Results

There was a total of 69 patients (median age 72 years (IQR 69-74)) - 40 were sulfonylurea-treated and 29 insulin-treated. 781 low sensor glucose events (<4.0mmol/L) were detected, of which 254 were very low sensor glucose events (<2.8mmol/L). Twenty-six out of 29 insulin-treated (89.6%) and 36 out of 40 sulphonylurea-treated patients (90%) contributed to the 781 events of low sensor glucose. Twenty out of 29 insulin-treated (69%) and 26 out of 40 sulphonylurea-treated patients (65.0%) contributed to the 254 very low sensor glucose events. Only 9% of all events were identified by patients. Nocturnal events represented 55.8% of low sensor glucose events and 61.0% of very low sensor glucose events. At a cut off of <2.8mmol/L, it was found that the insulin group had a significantly greater number of such events as compared to the sulfonylurea group.

Conclusions

This study demonstrates that elderly patients with tightly-controlled T2D have a significant number of low sensor glucose events which go by undetected.