Detection of asymptomatic drug-induced hypoglycemia using continuous glucose monitoring in older people - Systematic review
Open accessAbstract
AIM We conducted a systematic review of the use of continuous glucose monitoring (CGM) in older patients, in order to consolidate the growing evidence base in this area. METHODS Our protocol was registered on PROSPERO (CRD42017068523). We searched SCI Web of Science, Ovid SP MEDLINE and EMBASE from January 2010 to June 2017 for observational studies and randomized controlled trial of CGM in older patients (mean age 65 or older) with diabetes. We excluded studies that involved only hospitalized patients. Two reviewers independently extracted data blood sugar values (in particular, hypoglycemic episodes) captured with the use of CGM. We also assessed adverse events and acceptability of CGM. RESULTS After screening 901 abstracts, we included nine studies with a total of 989 older patients with diabetes. The CGM studies reveal that hypoglycemic episodes were occurring in a sizeable proportion (28-65%) of participants. Most (80-100%) of these episodes were asymptomatic, with some patients spending nearly 2 h per day in the hypoglycemic range. Older people with diabetes found CGM acceptable and experienced improved health-related well-being. CONCLUSION CGM frequently picks up asymptomatic hypoglycemic episodes in older patients with diabetes. Users of CGM report improved well-being, and reduction of diabetes-related stress.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
These studies do not capture the level 1 and level 2 hypoglycemia that represent the vast majority of hypoglycemic events, and they also substantially underestimate level 3 hypoglycemia.
“These studies do not capture the level 1 and level 2 hypoglycemia that represent the vast majority of hypoglycemic events, and they also substantially underestimate level 3 hypoglycemia (87,91,92).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [91]
The Evidence Synthesis (§3.2; page unavailable) reports that 80–100% of hypoglycemic events in the reviewed studies were asymptomatic and likely would have gone unnoticed without continuous glucose monitoring. This supports the point that many events are missed, but the paper does not establish that missed events were specifically level 1 or level 2, or that level 3 hypoglycemia was substantially underestimated. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Beck, R. W., Riddlesworth, T., Ruedy, K., Ahmann, A., Bergenstal, R., Haller, S., Kollman, C., Kruger, D., McGill, J. B., Polonsky, W., et al. (2017) · JAMA · doi:10.1001/jama.2016.19975 · Cited by 1,185 · cited 2× · see citing works
“a post-hoc analysis of older participants in the multi-centre DIAMOND RCT comparing CGM versus self-monitoring (16).”
BackgroundSelf-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin
Malanda, U. L., Welschen, L. M., Riphagen, I. I., Dekker, J. M., Nijpels, G., & Bot, S. D. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005060.pub3 · Cited by 358 · see citing works
Ruedy, K. J., Parkin, C. G., Riddlesworth, T. D., & Graham, C. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817704445 · Cited by 225 · see citing works
Frequent Hypoglycemia Among Elderly Patients With Poor Glycemic Control
Munshi, M. N. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.539 · Cited by 196 · see citing works
Young, L. A., Buse, J. B., Weaver, M. A., Vu, M. B., Mitchell, C. M., Blakeney, T., Grimm, K., Rees, J., Niblock, F., Donahue, K. E., et al. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.1233 · Cited by 148 · see citing works
Mattishent, K., & Loke, Y. K. (2015) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12587 · Cited by 121 · see citing works
Self-citationPistrosch, F., Ganz, X., Bornstein, S. R., Birkenfeld, A. L., Henkel, E., & Hanefeld, M. (2015) · Acta Diabetologica · doi:10.1007/s00592-015-0727-y · Cited by 76 · see citing works
The Impact of Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older
Polonsky, W. H., Peters, A. L., & Hessler, D. (2016) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816643542 · Cited by 69 · see citing works
Balijepalli, C., Druyts, E., Siliman, G., Joffres, M., Thorlund, K., & Mills, E. (2017) · Clinical Epidemiology · doi:10.2147/clep.s129268 · Cited by 52 · see citing works
Khunti, K. K., Fisher, H., Paul, S. K., Iqbal, M., Davies, M. J., & Siriwardena, A. N. (2013) · Primary care diabetes · doi:10.1016/j.pcd.2013.01.001 · Cited by 44 · see citing works
Litchman, M. L., & Allen, N. A. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817702657 · Cited by 44 · see citing works
Pazos-Couselo, M., López, J. M. G., González‐Rodríguez, M., Gudé, F., Santos, J. M. M., Rodríguez‐Segade, S., Rodríguez, J., & Casanueva, F. F. (2015) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2015.05.007 · Cited by 43 · see citing works
Ishikawa, T., Koshizaka, M., Maezawa, Y., et al. (2017) · Journal of Diabetes Investigation · doi:10.1111/jdi.12676 · Cited by 43 · see citing works
Meta-analysis: Association between hypoglycaemia and serious adverse events in older patients
Mattishent, K., & Loke, Y. K. (2016) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2016.03.018 · Cited by 40 · see citing works
Self-citationHypoglycemia in older adults with type 1 diabetes
DuBose, S. N., Weinstock, R. S., Beck, R. W., Peters, A. L., Aleppo, G., Bergenstal, R. M., Rodriguez, H., Largay, J. F., Massaro, E. M., Hirsch, I. B., et al. (2016) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2016.0268 · Cited by 36 · see citing works
Increasing Trend in the Number of Severe Hypoglycemia Patients in Korea
Kim, J. T., Oh, T. J., Lee, Y. A., Bae, J. H., Kim, H. J., Jung, H. S., Cho, Y. M., Park, K. S., Lim, S., Jang, H. C., et al. (2011) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2011.35.2.166 · Cited by 35 · see citing works
Personal Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older
Argento, N. B., & Nakamura, K. (2014) · Endocrine Practice · doi:10.4158/ep14017.or · Cited by 21 · see citing works
Chen, Y., Yang, C., Huang, L.-C., Chen, L., & Hwu, C. (2015) · Primary care diabetes · doi:10.1016/j.pcd.2015.04.002 · Cited by 17 · see citing works
Hypoglycemia in Frail Elderly Patients With Type 2 Diabetes Mellitus Treated With Sulfonylurea
van Dijk, P. R., Bouma, A., Landman, G. W. D., Groenier, K. H., Bilo, H. J. G., Kleefstra, N., & van Hateren, K. J. J. (2016) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816668873 · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s006 · Cited by 440 · see citing works
Grunberger, G., Sherr, J., Allende, M., Blevins, T., Bode, B., Handelsman, Y., Hellman, R., Lajara, R., Roberts, V. L., Rodbard, D., et al. (2021) · Endocrine Practice · doi:10.1016/j.eprac.2021.04.008 · Cited by 288 · see citing works
6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026.
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s006 · Cited by 172 · see citing works
Mattishent, K., & Loke, Y. K. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.571568 · Cited by 69 · see citing works
Self-citationFløde, M., Hermann, M., Haugstvedt, A., Søfteland, E., Igland, J., Åsberg, A., Jenssen, T. G., & Graue, M. (2023) · BMC Endocrine Disorders · doi:10.1186/s12902-023-01472-6 · Cited by 15 · see citing works
- Authors
- Mattishent, K., & Loke, Y. K.
- Affiliations
- University of East Anglia (GB)
- Corresponding author
- Mattishent, K.
- Venue
- Journal of Diabetes and its Complications
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 32
- Issue
- 8
- Pages
- 805-812
- ISSN
- 0891-6632 (ISSN-L)
- 1056-8727
- OpenAlex
- W2803488437
- Semantic Scholar
- 1032a9ea3c1207cae1d0c0c83f2a398f32a4a74b
- Cited by
- 38
- References
- 19
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 6 · 2023: 7 · 2022: 2 · 2021: 8 · 2020: 3 · 2019: 2 · 2018: 1
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- green
- ueaeprints.uea.ac.uk
- Locations
- Journal of Diabetes and its Complications (publishedVersion)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- Funders
- Alzheimer's Society (324 (AS-CTF-16-001))
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- continuous glucose monitoring, asymptomatic hypoglycemia, drug-induced hypoglycemia, older adults, diabetes mellitus, hypoglycemic episodes, health-related well-being, diabetes distress
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Humans, Hypoglycemia, Hypoglycemic Agents, Blood Glucose Self-Monitoring, Randomized Controlled Trials as Topic, Asymptomatic Diseases, Observational Studies as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
