ArticleJournal of the American Geriatrics Society2026
Burden and Risk Factors of CGM-Detected Hypoglycemia in Older Adults With Type 2 Diabetes.
Article in Journal of the American Geriatrics Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundComprehensive data on the burden of biochemical hypoglycemia in older adults with type 2 diabetes are lacking. We seek to characterize the burden and risk factors for hypoglycemia detected by continuous glucose monitoring (CGM) in older adults with type 2 diabetes.
methodsA cross-sectional analysis of 315 older adults with type 2 diabetes who attended visit 9 of the Atherosclerosis Risk in Communities Study (2021-2022). We examined rates of Level 1 hypoglycemia (< 70 mg/dL) and percentage meeting recommended targets for hypoglycemia (< 1% of time). We identified risk factors for CGM-detected hypoglycemia by comparing the median time spent in hypoglycemia across subgroups. All analyses were stratified by high-risk medication use (insulin/sulfonylureas vs. not).
resultsOf the 315 participants with type 2 diabetes (mean age 83 years, 55% women, 41% Black adults), 32.4% were using insulin or sulfonylureas. Among individuals using these high-risk medications, the median time spent in hypoglycemia was 3.4%, and ~66% of participants spent more than 1% of the time with CGM glucose < 70 mg/dL. Hypoglycemic episodes typically occurred overnight and lasted a median of ~1.5 h among individuals using insulin or sulfonylureas. CGM-detected hypoglycemia was low in participants not using high-risk medications (median time spent in hypoglycemia: 0.7%). In unadjusted analyses, cardiovascular disease, cognitive impairment, poor physical functioning, and chronic kidney disease were associated with increased time spent in hypoglycemia, regardless of high-risk medication use.
conclusionsThere may be a substantial burden of unrecognized CGM-detected hypoglycemia in very old adults with type 2 diabetes using high-risk medications in the general population. Hypoglycemia may also be present among persons not on high-risk medication, but the burden is much lower. Further research is needed to clarify the clinical significance of these hypoglycemic episodes.
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