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de Decker L, Hanon O, Boureau AS, et al. Association Between Hypoglycemia and the Burden of Comorbidities in Hospitalized Vulnerable Older Diabetic Patients: A Cross-Sectional, Population-Based Study. Diabetes Ther. 2017;8(6):1405-1413doi: 10.1007/s13300-017-0319-7.
de Decker, L., Hanon, O., Boureau, A. S., Chapelet, G., Dibon, C., Pichelin, M., Berrut, G., & Cariou, B. (2017). Association Between Hypoglycemia and the Burden of Comorbidities in Hospitalized Vulnerable Older Diabetic Patients: A Cross-Sectional, Population-Based Study. Diabetes therapy : research, treatment and education of diabetes and related disorders, 8(6), 1405-1413. https://doi.org/10.1007/s13300-017-0319-7
de Decker, Laure, et al. "Association Between Hypoglycemia and the Burden of Comorbidities in Hospitalized Vulnerable Older Diabetic Patients: A Cross-Sectional, Population-Based Study." Diabetes therapy : research, treatment and education of diabetes and related disorders vol. 8,6 (2017): 1405-1413. doi: https://doi.org/10.1007/s13300-017-0319-7
de Decker L, Hanon O, Boureau AS, Chapelet G, Dibon C, Pichelin M, Berrut G, Cariou B. Association Between Hypoglycemia and the Burden of Comorbidities in Hospitalized Vulnerable Older Diabetic Patients: A Cross-Sectional, Population-Based Study. Diabetes Ther. 2017 Dec;8(6):1405-1413. doi: 10.1007/s13300-017-0319-7. Epub 2017 Oct 30. PMID: 29086351; PMCID: PMC5688985.
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Diabetes Ther. 2017 Dec;8(6):1405-1413. doi: 10.1007/s13300-017-0319-7. Epub 2017 Oct 30.

Association Between Hypoglycemia and the Burden of Comorbidities in Hospitalized Vulnerable Older Diabetic Patients: A Cross-Sectional, Population-Based Study.

Diabetes therapy : research, treatment and education of diabetes and related disorders

Laure de Decker, Olivier Hanon, Anne-Sophie Boureau, Guillaume Chapelet, Christelle Dibon, Matthieu Pichelin, Gilles Berrut, Bertrand Cariou

Affiliations

  1. Laboratory of clinical and experimental therapeutics of infections, EA 3628, Nantes University, 44000, Nantes, France.
  2. Department of Geriatrics, Nantes University Hospital, 44000, Nantes, France.
  3. Department of Geriatrics, Broca Hospital, Public Hospital of Paris, 75013 Paris, France.
  4. Laboratory of Alzheimer disease : genetic and vascular markers, neuropsychology, psychosocial interventions and technologies, EA 4468, Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France.
  5. Department of Endocrinology, l'institut du thorax, Nantes University Hospital, 44000, Nantes, France.
  6. Department of Endocrinology, l'institut du thorax, Nantes University Hospital, 44000, Nantes, France. [email protected].

PMID: 29086351 PMCID: PMC5688985 DOI: 10.1007/s13300-017-0319-7

Abstract

INTRODUCTION: From a patient-centered perspective, the assessment of risk factors of hypoglycemia is of critical importance for the management of type 2 diabetes (T2D). However, the association between the occurrence of hypoglycemia and high burden of comorbidities has been poorly studied in vulnerable older patients. Here, we aimed to determine whether a high burden of comorbidities is associated with hypoglycemia in very old patients with T2D.

METHODS: A total of 1552 elderly (age ≥ 80 years old) patients with T2D were recruited in a nationwide cross-sectional study performed in French geriatric care units. Hypoglycemia was defined as a confirmed blood glucose value level ≤ 70 mg/dL. Comorbidities were assessed using the Charlson Comorbidity Index (CCI).

RESULTS: Amongst the 1552 recruited patients (mean age 86.4 years), 415 (26.7%) had documented hypoglycemia. Compared to patients in whom hypoglycemia was not reported, they have a lower body weight (p = 0.004), a reduced eGFR (p < 0.001), a greater level of dependency (p < 0.001) as well as history of dementia (p = 0.006) and cardiovascular disease (p < 0.001), and a higher CCI (4.7 vs 3.8, p < 0.001). Patients with hypoglycemia had a higher frequency of daily self-monitoring blood glucose (SMBG) (p < 0.001) and insulin use (p < 0.001), with reduced sulfonylurea use (p < 0.001). In multivariate logistic regression analysis, insulin therapy (OR 3.32, p < 0.001), daily SMBG (OR 1.79, p = 0.02), CCI (OR 1.24, p = 0.01), and age (OR 0.96, p = 0.03) were independently associated with the risk of hypoglycemia.

CONCLUSION: In addition to insulin therapy, a high burden of comorbidities was independently associated with hypoglycemia in older vulnerable patients with T2D.

Keywords: Charlson comorbidity index; Comorbidities; Diabetes; Hypoglycemia; Older patients

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