2-OR: Risk Factors for Continuous Glucose Monitoring (CGM)-Detected Hypoglycemia in Very Old Adults with Type 2 Diabetes

Introduction: Risk factors for hypoglycemia in very old adults with type 2 diabetes are uncharacterized. CGM identifies biochemical hypoglycemia but is not widely used in type 2 diabetes.

Methods: We conducted a cross-sectional analysis of 282 adults with type 2 diabetes (mean age 84 years; 32% using insulin or sulfonylureas [SUs]) in the Atherosclerosis Risk in Communities study (2021-2022). Participants wore the Abbott Libre Pro monitor (blinded) for up to 14 days. We examined the percentage of time participants had glucose readings <70 mg/dl (T<70), stratified by medication use. We considered T<70 separately during daytime (6:00AM-11:59 PM) and overnight (12:00AM-5:59 AM).

Results: There was substantial hypoglycemia in very old adults using insulin or SUs, especially overnight (median T<70: 5.1%) (Figure). In this population, females and those with cardiovascular disease, poor physical functioning, or a prior history of severe hypoglycemia experienced the most overnight hypoglycemia. T<70 was low in those not using insulin or SUs, but those with dementia were at an increased risk for overnight hypoglycemia.

Conclusion: Cardiovascular disease, functional impairment, and prior severe hypoglycemia were major risk factors for nocturnal hypoglycemia in very old adults using insulin or SUs. The benefits of CGM should be explored for these patients.