Introduction & Objective: Whether advanced age increases Level 3 severe hypoglycemia (SH) rates remains surprisingly unresolved by research, despite its often-presumed association. Leveraging iNPHORM data, we aimed to address this gap.
Methods: Adults (≥18 y.o.) with T1DM or T2DM on insulin and/or secretagogues were recruited from a US-wide, probability-based internet panel. Prospective data were captured via an online screener, baseline, and 12 monthly follow-up questionnaires. For complete cases with ≥1 follow-up, we estimated the total (unadjusted) population-average effect of age on annualized Level 3 SH rates by diabetes type using negative binomial regression with generalized estimating equations. An interaction term tested subgroup effects by age <65 vs ≥65 y.o. (α=0.05).
Results: N=978 were analyzed (T1DM: 16.7%; male: 49.6%; retention rate: 80.1%). The mean age was 51.0 (SD:14.3) (T1DM: 44.6 [SD:13.8]; T2DM: 52.2 [SD:14.1]) years; 20.4% (T1DM: 9.8%; T2DM: 22.5%) were ≥65 y.o. Level 3 SH incidence proportions were 44.2% (≥65 y.o.: 43.8%) in T1DM, and 31.8% (≥65 y.o.: 16.4%) in T2DM. Rates were 3.6 events per person-year (EPPY) (≥65 y.o.: 2.0 EPPY) in T1DM, and 5.3 EPPY (≥65 y.o.: 0.8 EPPY) in T2DM. The interaction term (<65 vs ≥65 y.o.) was statistically significant for T1DM (p=0.03) and T2DM (p<0.001). In T1DM, a 5-year increase in age reduced Level 3 SH rates by 23% (95%CI: 16%-30%, p<0.001) for those <65 y.o., and increased rates by 51% (95%CI: -15%-170%, p=0.16) for those ≥65 y.o. In T2DM, event rates decreased by 41% (95%CI: 38%-43%, p<0.001) for those <65 y.o., and increased by 21% (95%CI: -7%-57%, p=0.15) for those ≥65 y.o.
Conclusion: Level 3 SH rates declined with age until 65 y.o., when rates began to increase. Our results emphasize the need for age-specific hypoglycemia prevention. Clinical efforts should address the impact of advancing age among older adults, particularly those with T1DM; yet interventions targeting young adults, especially with T2DM, should not be overlooked.
A. Ratzki-Leewing: Research Support; Sanofi. Advisory Panel; Dexcom, Inc. Consultant; Abbott. Advisory Panel; Sanofi-Aventis U.S. Other Relationship; American Diabetes Association. Consultant; Novo Nordisk, Eli Lilly and Company. J.E. Black: None. G. Zou: None. B.L. Ryan: None. S.B. Harris: Consultant; Abbott. Research Support; Boehringer-Ingelheim. Consultant; Dexcom, Inc. Advisory Panel; Eli Lilly and Company. Consultant; Eli Lilly and Company, Novo Nordisk, Sanofi. Research Support; Novartis AG. Consultant; Bayer Inc.
The iNPHORM study was funded through an investigator-initiated grant from Sanofi Global.
