Severe hypoglycaemia in elderly patients with type 2 diabetes and coexistence of cardiovascular history

Abstract

A b s t r a c tBackground: Hypoglycaemia is a condition that occurs when blood glucose levels fall below 3.9 mmol/L (70 mg/dL), while hypoglycaemic coma is usually associated with glycaemia around 1.1 mmol/L (20 mg/dL). Recurrent severe hypoglycaemia may result in permanent neurological disorders and also has a negative impact on the cardiovascular system. Aim:To evaluate the causes of severe hypoglycaemia in elderly patients with type 2 diabetes and coexistence of cardiovascular history. Methods:We analysed retrospectively the history of 33 elderly patients with type 2 diabetes and coexistence of cardiovascular history, who were admitted to our clinic due to severe hypoglycaemia with loss of consciousness. The mean age of the patients was 76.0 ± 11.1 years, and the mean duration of diabetes was 12.0 ± 9.8 years. Glycated haemoglobin (HbA1c) was measured and the prevalence of cardiovascular diseases and therapeutic procedures were evaluated. Results:In the group of patients with severe hypoglycaemia, the mean value of HbA1c was 6.3 ± 1.2% (44 ± 13.1 mmol/mol), which indicates a mean glucose value below 7.8 mmol/L (140 mg/dL). Ischaemic heart disease was diagnosed in 18 patients (eight had a history of myocardial infarction), and 22 patients had arterial hypertension. Severe hypoglycaemia requiring hospitalisation in elderly patients with type 2 diabetes and coexistence of cardiovascular history was related to insulin or sulfonylurea therapy. Conclusions:A low HbA1c level indicates inappropriate intensification of therapy and was associated with high risk of severe hypoglycaemic episodes in older people. The majority of severe hypoglycaemic episodes were observed in sulphonylurea or insulin-treated type 2 diabetic patients.

Analysis of Risk Factors for Hypoglycemic Coma in 194 Patients with Type 2 Diabetes

“…The prevalence of diabetes in people over the age of 18 has reached 11.6%, with a corresponding increase in the incidence of diabetes complications. Hypoglycemia is most commonest in patients with type 1 diabetes [ 3 ], and its incidence in patients with type 2 diabetes is also high [ 4 , 5 ]. Hypoglycemic coma may also cause serious damage to the body, or even death [ 6 ].…”

Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition)

“…(3) Grade 3 hypoglycemia: Severe events requiring assistance from others, accompanied by changes in consciousness and/or body, but without specific blood glucose limits 202 . Due to the strong heterogeneity of the elderly population and the lack of hypoglycemia studies specifically in this group, coupled with the absence of unified diagnostic criteria for hypoglycemia in different studies, there is a lack of large‐scale epidemiological data on the incidence of hypoglycemia in elderly diabetes patients in China. Risk factor: Age is one of the risk factors for hypoglycemia 203 ; the risk of hypoglycemia is higher in older patients with diabetes than in non‐elderly ones 204 . In addition to the age actor, compromised ability of glucose regulation, multiple concurrent diseases (e.g., CKD, cardiovascular disease, hepatic insufficiency, etc.…”

“… Risk factor: Age is one of the risk factors for hypoglycemia 203 ; the risk of hypoglycemia is higher in older patients with diabetes than in non‐elderly ones. 204 In addition to the age actor, compromised ability of glucose regulation, multiple concurrent diseases (e.g., CKD, cardiovascular disease, hepatic insufficiency, etc. ), polypharmacy, and concurrent autonomic neuropathy are all risk factors for hypoglycemia in older patients with diabetes.…”

The Giant Geriatric Syndromes Are Intensified by Diabetic Complications

“…Despite this tremendous statistics, a lot of studies on diabetes treatment exclude patients older than 65 years. Practically, all of them disregard patients older than 75 years and only a small fraction targets elderly people (Avorn, 1995; Lakey et al, 2013; Piątkiewicz et al, 2014). There are stipulations driven by demographic changes to remove the upper age limit for clinical trials, from 65 years to no restrictions (Shenoy & Harugeri, 2015).…”