Background: As T1D patients routinely reach older age, more information is needed to understand the impact of aging on the risk of hypoglycemia and its interaction with other age-related issues.
Methods: We evaluated 2 groups of patients with T1D: older (age >65 years) and younger (age 18-35 years). All patients were subjected to either blinded CGM for 2 weeks or assessment of personal CGM. A hypoglycemia fear survey (HFS II), and a Clarke hypoglycemia unawareness survey were completed. Patients were also assessed for cognitive function by the Montreal Cognitive Assessment (MoCA). Glycemic control was measured by A1C.
Results: We evaluated 56 patients with T1D; 23 in the older and 33 in the younger group. The average age was 70 vs. 28 years; diabetes duration 36 vs. 14 years; A1C 8.0% vs. 7.9%, respectively. Clinically significant hypoglycemia (glucose ?54 mg/dL for > 15 mins/episode) occurred equally in 91% of older (mean 28 minutes/day) and 88% of younger (mean 23 mins/day) patients. Older patients reported hypoglycemia unawareness more (39% vs. 30%), with similar scores on HSF II (34 vs. 33). However, 61% of older patients had cognitive impairment (MoCA score <26) compared to 12% in younger adults. There was a higher comorbidity burden in older patients (average number of comorbidities 4 vs. 1), with a higher number of daily medications (10 vs. 4).
Conclusion: The risk of hypoglycemia is similar in older and younger patients with T1D. However, higher incidence of comorbidities including cognitive dysfunction and polypharmacy may increase the risk of poor outcomes due to hypoglycemia.
M. Munshi: Consultant; Self; Sanofi. C. Slyne: None. A. Atakov-Castillo: None. J. Greenberg: None. T. Greaves: None. S.P. Carl: None. E. Toschi: None.