Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes

Background: Little is known about the prevalence of hypoglycaemia in older people with diabetes. However, the HbA1c goal is >= 8% for institutionalised patients with treatments that can cause hypoglycaemia. Purpose: We aimed to assess the prevalence of hypoglycaemia with continuous glucose monitoring and to evaluate the link with HbA1C in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs. Design: Prospective, multicentre study carried out in six geriatric care centres in the Cote d'Or region of France between January 2019 and July 2020. Settings, subjects and methods: A FreeStyle Libre Pro (R) (FSLP) was worn for up to 14 days in blinded mode in 42 patients taking at least one potentially hypoglycaemia-inducing antidiabetic drug. Results: Two hundred and forty-two hypoglycaemic events were detected in 79% (n= 33) of patients wearing the FSLP. One or more hypoglycaemic event was detected in 100% of patients with HbA1C< 7% and in 79% of patients with HbA1C >= 8% (P = 0.02). The time spent in hypoglycaemia was higher in patients with HbA1C< 7% than those with HbA1C >= 8% (P = 0.015). Time spent <54 mg/dl was detected in 45% of patients. Conclusions: We report a very high prevalence of hypoglycaemia, with a significant proportion of severe hypoglycaemia, in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs. Having HbA1C< 7% exposes patients to a higher risk of hypoglycaemia, but this risk remains also high in patients with HbA1C >= 8%. In this population, continuous glucose monitoring could be considered an effective tool to detect hypoglycemia, which is associated with increased risk of cardiovascular events, falling, fractures, cognitive impairment and mortality.