Hypoglycemia and glycemic control in older adults with type 1 diabetes: baseline results from the WISDM study
Open accessAbstract
Background Knowledge regarding the burden and predictors of hypoglycemia among older adults with type 1 diabetes (T1D) is limited. Methods We analyzed baseline data from the Wireless Innovations for Seniors with Diabetes Mellitus (WISDM) study, which enrolled participants at 22 sites in the United States. Eligibility included clinical diagnosis of T1D, age ≥60 years, no real-time continuous glucose monitoring (CGM) use in prior three months, and HbA1c Results Median age of the cohort was 68 years (52% female, 93% non-Hispanic white, and 53% used insulin pumps). Mean HbA1c was 7.5%. Median time spent in the glucose range P = .03). Participants spent a mean 56% of total time in target glucose range of 70-180 mg/dL and 37% of time above 180 mg/dL. Conclusions Over half of older T1D participants spent at least an hour a day with glucose levels <70 mg/dL. Those with reduced hypoglycemia awareness spent over twice as much time than those without in a serious hypoglycemia range (glucose levels <54 mg/dL). Interventions to reduce exposure to clinically significant hypoglycemia and increase time in range are urgently needed in this age group.
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Among secondary outcomes in the WISDM trial, time spent in range between 70 and 180 mg/dL increased by 8% and glycemic variability decreased.
“Among secondary outcomes, time spent in range between 70 and 180 mg/dL increased by 8% (95% CI 6.0-11.5)and glycemic variability (%CV) decreased.”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [38]
In the WISDM trial, over 6 months, use of continuous glucose monitoring in adults over 60 years of age with type 1 diabetes resulted in a small but statistically significant reduction in time spent with hypoglycemia (glucose level <70 mg/dL) compared with standard blood glucose monitoring.
“Over 6 months, use of CGM resulted in a small but statistically significant reduction in time spent with hypoglycemia (glucose level <70 mg/dL) compared with standard blood glucose monitoring (adjusted treatment difference À1.9% [À27 min/day]; 95% CI À2.8% to À1.1% [À40 to À16 min/day]; P < 0.001) (38,39).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [38]
In the WISDM trial, over 6 months, use of CGM in adults over 60 years with type 1 diabetes resulted in a small but statistically significant reduction in time spent with hypoglycemia (glucose level <70 mg/dL) compared with standard blood glucose monitoring.
“Over 6 months, use of CGM resulted in a small but statistically significant reduction in time spent with hypoglycemia (glucose level <70 mg/dL) compared with standard blood glucose monitoring (adjusted treatment difference À1.9% [À27 min/day]; 95% CI À2.8% to À1.1% [À40 to À16 min/day]; P < 0.001) (40,41).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [40]
Among secondary outcomes in WISDM, time spent in range between 70 and 180 mg/dL increased by 8% and glycemic variability decreased.
“Among secondary outcomes, time spent in range between 70 and 180 mg/dL increased by 8% (95% CI 6.0-11.5)and glycemic variability (%CV) decreased.”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [40]
Older adults with type 1 diabetes mellitus are particularly vulnerable to sequelae of severe hypoglycaemia.
“Older adults with T1DM are particularly vulnerable to sequelae of severe hypoglycaemia8”
From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [8]
CGM devices are acceptable to people of all age-groups, including older individuals with type 1 diabetes or insulin-requiring type 2 diabetes.
“Continuous glucose monitoring (CGM) devices have been shown to be effective at improving glycemic management and acceptable to people of all age-groups, including older individuals with type 1 diabetes (44–48) or insulin-requiring type 2 diabetes (49,50).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [44]
CGM devices have been shown to be effective at improving glycemic management.
“Continuous glucose monitoring (CGM) devices have been shown to be effective at improving glycemic management and acceptable to people of all age-groups, including older individuals with type 1 diabetes (44–48) or insulin-requiring type 2 diabetes (49,50).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [44]
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BackgroundMethodResultInternational consensus on use of continuous glucose monitoring
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13. Older Adults: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s013 · Cited by 381 · see citing works
13. Older Adults: Standards of Care in Diabetes—2025
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13. Older Adults: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Hilliard, M. E., Johnson, E. L., Khunti, K., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s013 · Cited by 161 · see citing works
Self-citation13. 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
Self-citationThe epidemiology of type 1 diabetes mellitus in older adults
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“Older adults with T1DM are particularly vulnerable to sequelae of severe hypoglycaemia 8 and have an increased risk of cognitive decline 9 , depression 10 and frailty 11 .”
- Authors
- Carlson, A. L., Kanapka, L. G., Miller, K. M., Ahmann, A. J., Chaytor, N. S., Fox, S., Kiblinger, L., Kruger, D., Levy, C. J., Peters, A. L., Rickels, M. R., Salam, M., Shah, V. N., Young, L. A., Kudva, Y. C., Pratley, R., & for the WISDM Study Group
- Affiliations
- Park Nicollet International Diabetes Center, Minneapolis, MN, USA
- Jaeb Center for Health Research (US)
- Oregon Health & Science University (US)
- Washington State University Spokane (US)
- University of Southern California (US)
- Atlanta Diabetes Associates (US)
- Henry Ford Health (US)
- Icahn School of Medicine at Mount Sinai (US)
- University of Pennsylvania (US)
- Washington University in St. Louis (US)
- Barbara Davis Center for Diabetes, Aurora, CO, USA
- University of North Carolina at Chapel Hill (US)
- Mayo Clinic (US)
- Advent Health, Orlando, FL, USA
- ORCID
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2019-12-21
- Volume
- 15
- Issue
- 3
- Pages
- 582-592
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC8120041
- OpenAlex
- W2995224057
- Cited by
- 43
- References
- 11
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 5 · 2023: 11 · 2022: 7 · 2021: 2 · 2020: 4
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Leona M. and Harry B. Helmsley Charitable Trust
- Juvenile Diabetes Research Foundation (3-SRA-2017-425-M-R)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 1 diabetes, older adults, hypoglycemia, glycemic control, hypoglycemia awareness, continuous glucose monitoring, time in range, HbA1c, insulin pump
- MeSH terms
- Glycemic Control, Aged, Blood Glucose, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Male, Middle Aged, Blood Glucose Self-Monitoring
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