The effects of aging and frailty on inpatient glycemic control by continuous glucose monitoring in patients with type 2 diabetes

BACKGROUND

Older adults with diabetes in the hospital are generally managed similarly to younger adults, however, it is unknown if the degree of frailty can affect glucose control among hospitalized patients.

METHODS

We examined glycemic parameters derived from continuous glucose monitoring (CGM) in older adults with type 2 diabetes and frailty who were hospitalized in non-acute settings. Data was pooled from 3 prospective studies using CGM including 97 patients wearing Libre CGM sensors and 166 patients wearing Dexcom G6 CGM. Glycemic parameters (time in range (TIR) 70-180; time below range (TBR) <70 and 54 mg/dl) by CGM were compared between 103 older adults ≥60 years and 168 younger adults <60 years. Frailty was assessed using validated laboratory and vital signs frailty index FI-LAB (n = 85), and its effect on hypoglycemia risk was studied.

RESULTS

Older adults, as compared to younger adults, had significantly lower admission HbA1c (8.76% ± 1.82 vs. 10.25% ± 2.29, p < 0.001), blood glucose (203.89 ± 88.65 vs. 247.86 ± 124.17 mg/dl, p = 0.003), mean daily BG (173.9 ± 41.3 vs. 183.6 ± 45.0 mg/dl, p = 0.07) and higher percent TIR 70-180 mg/dl (59.0 ± 25.6% vs. 51.0 ± 26.1%, p = 0.02) during hospital stay. There was no difference in hypoglycemia occurrence between older and younger adults. Higher FI-LAB score was associated with higher % CGM < 70 mg/dl (0.204) and % CGM < 54 mg/dl (0.217).

CONCLUSION

Older adults with type 2 diabetes have better glycemic control prior to admission and during hospital stay compared to younger adults. Frailty is associated with longer presence of hypoglycemia in non-acute hospital settings.

LBSUN215 Evaluation Of Glycemic Control By Continuous Glucose Monitoring Among Hospitalized Older Adults With Type-2 Diabetes And Frailty

 

Recent observational and meta-analyses have reported a frailty prevalence between 10% and 25% in people with diabetes, in particular in those older than 60 years of age. The impact of frailty on hospital glycemic control and glycemic variability (GV) by continuous glucose monitoring (CGM) in insulin-treated older adults with type 2 diabetes (T2D) is not known. Accordingly, we reviewed data from 3 inpatient randomized clinical trials using CGM in insulin-treated patients with T2D. The validated laboratory-based frailty index (FI-LAB) scale was used for frailty assessment, and participants were categorized into three groups [non-frail: (0-<0.1), pre-frail (≥0.1-<0.21), and frail (≥0.21)] in 84 older adults. | There were no differences on admission clinical characteristics between the non-frail/pre-frail older adults and the frail older adults except for Creatinine (BMI: 32.4 ± 9 vs. 36.83± 13, p=0.21; HbA1c%: 9.3 ± 2 vs. 8.72± 2, p=0.18; Admission BG: 227 ± 114 vs. 194. 07± 75 mg/dl, p=0.26; Cr: 1.16 ± 1 vs. 1.65± 1. 0). There were no differences in GV by coefficient of variation (CV), amplitude of glucose excursion (MAGE), and standard deviation (SD) between the two groups. The correlation between FI-LAB score and percent time with CGM <70 was 0.204 (p=0. 064) and the correlation between FI-LAB score and percent time with percent time with CGM<54 was 0.217 (p=0. 049). Results from standard linear regression and zero-inflated Beta regression further suggest that frail old patients with higher frailty scores may be associated with larger percent time with CGM below range <70 and CGM <54 mg/dL.

Conclusion

Our results indicate that older adults with T2D with higher frailty score experience more time in hypoglycemia during their hospital stay despite having comparable mean daily blood glucose, time in range and glycemic variability compared to non-frail or pre-frail older adults. A larger prospective study is needed to confirm these findings and determine the impact of frailty on clinical outcome. Providers should be vigilant when using insulin or insulin secretagogues in hospitalized older adults with diabetes and frailty.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.