Adults with type 1 diabetes (T1D) using insulin pump have a lower risk of hypoglycemia than those using multiple daily injections (MDI). However, it is not clear if these benefits are maintained in the older adult population.
Methods: We evaluated a cohort of older adults (age≥ 65 years) with T1D. All participants underwent continuous glucose monitoring (CGM) for 2 weeks along with questionnaires and assessments for hypoglycemia fear (HFS II), hypoglycemia unawareness (Clarke method), cognitive function (Montreal Cognitive Assessment (MoCA)), and demographic and medical history. Glycemic control was measured by A1C.
Results: We evaluated 86 older adults, 32 on MDI and 54 on insulin pump. Average age was 71 years in both cohorts, diabetes duration 36 and 41 years, and A1C 7.5% and 7.4%, respectively. Participants using MDI had more clinically significant hypoglycemia (glucose ≤54 mg/dl) than those using an insulin pump (48 minutes/day vs. 26 minutes/day, p<0.05). Hypoglycemia unawareness and cognitive dysfunction did not differ between the groups (40% vs. 45%; 65% vs. 45%: p=ns respectively). The total scores on HFS II describing hypoglycemia fear were similar in both groups (32 vs. 25). However, participants using MDI were more fearful of hypoglycemia at night (p=0.03), and were more likely to keep their blood sugar higher than usual in social situations (p=0.03), or when doing important tasks (p=0.002).
Conclusions: Older adults with T1D using MDI had a higher risk of clinically significant hypoglycemia despite similar glucose control and hypoglycemia unawareness. Further studies are needed to understand the role of insulin administration methods on risk of hypoglycemia in older adults with T1D.
E. Toschi: Advisory Panel; Self; Lexicon Pharmaceuticals, Inc. C. Slyne: None. J. Greenberg: None. A. Atakov-Castillo: None. A.B. Dufour: None. K. Sifre: None. S. Carl: None. M. Munshi: Consultant; Self; Lilly Diabetes, Sanofi.
National Institute of Diabetes and Digestive and Kidney Diseases