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Nursing home care, impaired awareness raise risk for severe hypoglycemia in type 1 diabetes
Patients with type 1 diabetes living in a nursing home facility are more likely to experience episodes of severe hypoglycemia, whereas depression, pump therapy and the use of short-acting insulin analogues may be protective of the condition, according to results from an 8-year retrospective comparative study.
Tobias Wohland, MSc, of Leipzig University Medical Center in Germany, and colleagues assessed 206 patients treated for severe hypoglycemia at Lippe-Detmold Hospital, a large tertiary care hospital in East Westphalia, Germany, between 2007 and 2014. Severe hypoglycemia was defined as an event requiring treatment with IV glucose or glucagon administration, and a blood glucose measurement of less than 2.8 mmol/L. Researchers also analyzed a control group of 189 patients with type 1 diabetes treated at an outpatient diabetes center who were not treated for severe hypoglycemia.
Among the 206 patients treated for severe hypoglycemia, 405 cases were documented; 50% of episodes were related to 31 patients who experienced at least three events. Compared with controls, patients experiencing severe hypoglycemia tended to have a lower BMI, lower insulin dosages, lower creatinine clearance, increased impairment of cognitive function and were more frequently taken into care. Among patients treated for severe hypoglycemia, 24.3% had been treated with beta-blocker therapy; these patients experienced impaired hypoglycemia awareness more than those not receiving beta-blocker treatment (46% vs. 27%). However, use of beta-blocker therapy did not appear to be a risk factor, the researchers noted.
Researchers found that a need for nursing care (OR = 4.88; 95% CI, 1.41-22.63), treatment with NPH insulin (OR = 3.68; 95% CI, 1.64-8.91) and impaired hypoglycemia awareness (OR = 2.06; 95% CI, 1.09-3.93) were the strongest risk factors for severe hypoglycemia (P < .05 for all).
In contrast, researchers found that depression (OR = 0.14; 95% CI, 0.02-0.51), treatment with insulin pump therapy (OR = 0.39; 95% CI, 0.22-0.68) and short-acting insulin analogues (OR = 0.31; 95% CI, 0.18-0.53) appeared to be protective (P < .1 for all).
Patients who had previously experienced recurrent severe hypoglycemia were more likely to experience it again, according to researchers. In Cox regression analysis, patients with two or more events of severe hypoglycemia before 2012 had a 2.9-fold higher risk of experiencing a recurrent episode vs. those with a no events or a maximum of two events before 2012.
“The susceptible group of patients with recurrent [severe hypoglycemia] remains a therapeutic issue and should especially be included in studies of new interventions that may help to guide future therapeutic strategies,” the researchers wrote. “Future structures of diabetes care will be challenged by the need of treating increasingly geriatric subjects with [type 1 diabetes] having a high risk of [severe hypoglycemia].” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.