Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes
Open accessAbstract
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 Côte d’Or region of France between January 2019 and July 2020. Settings, subjects and methods: A FreeStyle Libre Pro® (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.
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This population of older adults in PALTC facilities is at increased risk for hypoglycemia.
“thus showing that this population of older adults in PALTC facilities are at increased risk for hypoglycemia (159,160).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [160]
The Discussion reports that 79% of the studied older institutionalised patients had at least one hypoglycaemic event during 14 days of monitoring. But the study population was limited to patients with diabetes taking potentially hypoglycaemia-inducing drugs; it does not establish increased risk for older adults in PALTC facilities generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAdditional studies of older adults with diabetes living in PALTC facilities using CGM revealed a high prevalence of hypoglycemia both in people using insulin and in those using sulfonylureas.
“Additional studies of older adults with diabetes living in PALTC facilities using CGM revealed a high prevalence of hypoglycemia both in people using insulin and in those using sulfonylureas, thus showing that this population of older adults in PALTC facilities are at increased risk for hypoglycemia (159,160).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [160]
The Discussion reports that CGM detected hypoglycaemia in 79% of the older institutionalised patients studied. The Characteristics of the study population section says 76% received insulin and 55% received sulfonylureas or repaglinide, but the paper does not report a separate hypoglycaemia prevalence for sulfonylurea users or for each treatment group. (LLM, conf=0.82)
Experimental — accuracy not yet measuredCGM may be a useful approach to monitoring for and preventing hypoglycemia among individuals treated with insulin in PALTC.
“CGM may be a useful approach to monitoring for and preventing hypoglycemia among individuals treated with insulin in PALTC (160,161,168).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [160]
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Cited by
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Continuous glucose monitoring for the routine care of type 2 diabetes mellitus
Ajjan, R. A., Battelino, T., Cos, X., Del Prato, S., Philips, J.-C., Meyer, L., Seufert, J., & Seidu, S. (2024) · Nature Reviews Endocrinology · doi:10.1038/s41574-024-00973-1 · Cited by 117 · see citing works
13. Older Adults: 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-s013 · Cited by 87 · see citing works
Idrees, T., Castro-Revoredo, I. A., Oh, H. D., Gavaller, M. D., Zabala, Z., Moreno, E., Moazzami, B., Galindo, R. J., Vellanki, P., Cabb, E., et al. (2024) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2024.01.031 · Cited by 22 · see citing works
- Authors
- Bouillet, B., Tscherter, P., Vaillard, L., Nonciaux, C., Hourdain, P., Ravier, A., Rouland, A., Petit, J. M., Vergès, B., & Quilot, E.
- Affiliations
- Inserm (FR)
- CHU Dijon Bourgogne (FR)
- Hospital of Champmaillot, Dijon University Hospital, France
- EHPAD “Port du Canal”, Dijon, France
- EHPAD « Combe Sainte Victor », Neuilly-les-Dijon, France
- EHPAD « Les Fassoles », Talant, France
- Corresponding author
- Bouillet, Benjamin
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-07-27
- Volume
- 50
- Issue
- 6
- Pages
- 2088-2093
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- OpenAlex
- W3185156130
- Cited by
- 29
- References
- 1
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 3 · 2023: 7 · 2021: 1
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Age and Ageing (publishedVersion)
- PubMed (publishedVersion)
- 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 › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- hypoglycemia, severe hypoglycemia, older adults, institutionalized patients, diabetes mellitus, continuous glucose monitoring, HbA1c, antidiabetic drugs, hypoglycemia risk, elderly care
- MeSH terms
- Aged, Blood Glucose, Diabetes Mellitus, Type 2, Humans, Hypoglycemia, Hypoglycemic Agents, Prospective Studies, Blood Glucose Self-Monitoring
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