Hypoglycaemia in elderly diabetics


Authors: Marián Mokáň;  Peter Galajda
Authors‘ workplace: I. Interná klinika JLF UK a UN Martin
Published in: Forum Diab 2020; 142(3): 153-157
Category:

Overview

Hypoglycaemia is limiting factor of treatment of patients with diabetes mellitus. Older age is significant risk factor for hypoglycaemia and incidence of hypoglycaemia is significantly increased after age of 75 years. Neurological symptoms without warning autonomic signs occur more often in older age. Hypoglycaemia in these patients have severe consequences and can worsen their survival. Risk factors of hypoglycaemia in older patients include co­gnitive dysfunction, dementia, cardiovascular diseases, chronic kidney disease and other comorbidities. In older patients with higher risk of hypoglycaemia we prefer less strict glycaemic control and treatment with low risk of hypoglycaemia.

Keywords:

cardiovascular diseases – chronic kidney disease – cognitive dysfunction – dementia – diabetes mellitus – hypoglycaemia – older age


Sources
  1. Mokáň M. Hypoglykémia. Vydavateľstvo P+M: Turany 2005. ISBN 978–80–9687–426–8.
  2. Mokáň M, Galajda P. Hypoglykémia u pacientov s diabetes mellitus. Quick-Print: Martin 2019. ISBN 978–80972594–5-7. 2.
  3. Uličiansky V, Schroner Z, Galajda P et al (eds). Diabetes mellitus v zrelom veku. Quick Print: Martin 2013. ISBN 978–80–971417–1-4.
  4. Abdelhafiz AH, Rodriguez-Mains L, Morley JE et al. Hypoglycemia in older people – A less well recognized risk factor for frailty. Aging Dis 2015; 6(2): 156–167. Dostupné z DOI: <http://dx.doi.org/10.14336/AD.2014.0330>.
  5. Matyka K, Evans M, Lomas J et al. Altered hierarchy of protective responses against severe hypoglycemia in normal aging in healthy men. Diabetes Care 1997; 20(2): 135–141. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.20.2.135>.
  6. Bonds DE, Miller ME, Dudl J et al. Severe hypoglycemia symptoms, antecedent behaviors, immediate consequences and association with glycemia medication usage: Secondary analysis of the ACCORD clinical trial data. BMC Endocr Disord 2012; 12: 5. Dostupné z DOI: <http://dx.doi.org/10.1186/1472–6823–12–5>.
  7. Shorr RI, Ray WA, Daugherty JR, Griffin MR. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas. Arch Intern Med 1997; 157(15): 1681–1686.
  8. Pathak RD, Schroeder EB, Seaquist ER et al. Severe hypoglycemia requiring medical intervention in a large cohort of adults with diabetes receiving care in U.S. Integrated Health Care Delivery Systems: 2005–2011. Diabetes Care 2016; 39(3): 363–370. Dostupné z DOI: <http://dx.doi.org/10.2337/dc15–0858>.
  9. Yanai H, Adachi H, Katsuyama H et al. Causative anti-diabetic drugs and the underlying clinical factors for hypoglycemia in patients with diabetes. World J Diabetes 2015; 6(1): 30–36. Dostupné z DOI: <http://dx.doi.org/10.4239/wjd.v6.i1.30>.
  10. Leese GP, Wang J, Broomhall J et al. Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use. Diabetes Care 2003; 26(4): 1176–1180. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.26.4.1176>.
  11. Hornick T, Aron DC. Managing diabetes in the elderly. Go easy, individualize. Cleve Clin J Med 2008; 75(1): 70–78. Dostupné z DOI: <http://dx.doi.org/10.3949/ccjm.75.1.70>.
  12. [American Diabetes Association]. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2019 Diabetes Care 2019; 42(Suppl 1): S34-S45. Dostupné z DOI: <http://dx.doi.org/10.2337/dc19-S004>.
  13. Aung PP, Strachan MW, Frier BM et al. Severe hypoglycaemia and late-life cognitive ability in older people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabet Med 2012; 29(3): 328–336.Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464–5491.2011.03505.x>.
  14. Mijnhout GS, Scheltens P, Diamant M et al. Diabetic encephalopathy: a concept in need of a definition. Diabetologia 2006; 49(6): 1447–1448. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–006–0221–8>.
  15. Punthakee Z, Miller ME, Launer LJ et al. Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial. Diabetes Care 2012; 35(4): 787–793. Dostupné z DOI: <http://10.2337/dc11–1855>.
  16. Mattishent K, Loke YK. Bi-directional interaction between hypoglycaemia and cognitive impairment in elderly patients treated with glucose agents: review and meta-analysis. Diabetes Obes Metab 2016; 18(2): 135–141. Dostupné z DOI: <http://dx.doi.org/10.1111/dom.12587>.
  17. Yaffe K, Falvey CM, Hamilton N et al. Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med. 2013; 173(14): 1300–1306. Dostupné z DOI: <http://dx.doi.org/10.1001/jamainternmed.2013.6176>.
  18. Sheen YJ, Sheu WHH. Association between hypoglycemia and dementia in patients with type 2 diabetes. Diab Res Clin Pract 2016; 116: 279–287. Dostupné z DOI: <http://10.1016/j.diabres.2016.04.004>.
  19. Mokáň M, Galajda P. Hypoglykémia pri vybraných vnútorných chorobách. Quickprint: Martin 2011. ISBN 978–80–970660–6-2.
  20. Gerstein HC, Miller ME, Byington RP et al. [Action to Control Cardiovascular Risk in Diabetes Study Group]. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358(24): 2545–2559. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0802743>.
  21. Patel A, MacMahon S, Chalmers J et al. [ADVANCE Collaborative group]. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358(24): 2560–2572. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0802987>.
  22. Duckworth W, Abraira C, Moritz T et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360(2): 129–139. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0808431>.
  23. Holman RR, Paul SK, Bethel A et al. 10-Year follow-up of intensive glucose control in type 2 diabetes. N Eng J Med 2008; 359(15): 1577–1589. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0806470>.
  24. Turnbull FM, Abraira C, Andersoon RJ et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 2009; 52(1): 2288–2298. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–009–1470–0>.
  25. Tkáč I. Effect of intensive glycemic control on cardiovascular outcomes and all-cause mortality in type 2 diabetes: Overview and metaanalysis of five trials. Diab Res Clin Pract 2009; 86(Suppl 1): S57-S62. Dostupné z DOI: <http://dx.doi.org/10.1016/S0168–8227(09)70011–7>.
  26. Mokáň M, Galajda P. Hypoglykémia ako rizikový kardiovaskulárny faktor. Forum Diab 2014; 3(1): 20–27.
  27. Hsu PF, Sung SH, Cheng HM et al. Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes: a nationwide population-based study. Diabetes Care 2013; 36(4): 894–900. Dostupné z DOI: <http://dx.doi.org/10.2337/dc12–0916>.
  28. Samoš M, Galajda P, Mokáň M et al. Hypoglykémia u pacientov hospitalizovaných na internom oddelení: prevalencia a najčastejšie príčiny jej vzniku. Forum Diab 2014; 3(1): 34–39.
  29. Mokáň M, Galajda P, Prídavková D. Riziko hypoglykémie u pacientov s diabetes mellitus a komorbiditami. Forum Diab 2020; 9(1): 7–12.
Labels
Diabetology Endocrinology Internal medicine
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