Background: The impact of aging on insulin-dependent diabetes is not well studied.
Methods: We evaluated insulin-dependent older adults (age >65 years) with type 1(T1D) and type 2 diabetes (T2D). All patients completed questionnaires for demographics, hypoglycemia fear survey (HFS II), hypoglycemia unawareness (Clarke’s method) and assessment of comorbidities. A1c was measured, and blinded CGM was performed over 2-week period.
Results: We evaluated 32 insulin-dependent older adults: 23 had T1D (age 70±4 years, A1C 8%) and 9 had T2D (age 80±9 years, A1C 8.9%). All with T1D were either on insulin pump or on ≥4 insulin injections/day compared to 55% of patients with T2D. Clinically significant hypoglycemia (glucose < 55 mg/dl for ≥ 20 mins/episode) was observed in 91% of patients with T1D (21 of 23), compared with 22% with T2D (2 of 9). Nocturnal hypoglycemic episodes (10 pm-6 am) were observed in 15 out of 23 (65%) T1D patients, compared to 1 out of 9 (11%) with T2D. Older adults with T1D had greater fear of hypoglycemia as shown by HFS II score of 34 compared to 15 in T2D. However, hypoglycemia unawareness was similar in the two groups (9 of 23 (39%) with T1D, and 3 of 9 (33%) with T2D. Age-associated comorbidities in T1D and T2D older adults included Cognitive impairment (68% vs. 100%), depression (27% vs. 43%), recent falls within 6-months (24% vs. 43%), vision impairment (27% vs. 43%), and hearing impairment (36% vs. 50%) respectively.
Conclusions: Insulin-dependent older adults with T1D have a higher risk of total and nocturnal hypoglycemia compared to older adults with T2D. Associated multiple age-related comorbidities put them at higher risk of poor outcomes.
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.
