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Open Access Highly Accessed Original investigation

Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia

Peter Bramlage1*, Anselm K Gitt23, Christiane Binz4, Michael Krekler4, Evelin Deeg2 and Diethelm Tschöpe56

Author Affiliations

1 Institut für Pharmakologie und präventive Medizin, Menzelstrasse 21, 15831, Mahlow, Germany

2 Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany

3 Herzzentrum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany

4 Bristol Myers Squibb, Medical Department, Munich, Germany

5 Stiftung “Der herzkranke Diabetiker” in der Deutschen Diabetes Stiftung, Bad Oeynhausen, Germany

6 Herz- und Diabeteszentrum Nordrhein-Westfalen in Bad Oeynhausen, Universitätsklinik der Ruhr Universität, Bochum, Germany

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Cardiovascular Diabetology 2012, 11:122  doi:10.1186/1475-2840-11-122

Published: 6 October 2012

Abstract

Background

We aimed at identifying variables predicting hypoglycemia in elderly type 2 diabetic patients and the relation to HbA1c values achieved.

Design

Prospective, observational registry in 3810 patients in primary care. Comparison of patients in different age tertiles: with an age < 60 (young, n=1,253), age 60 to < 70 (middle aged, n=1,184) to those ≥ 70 years (elderly, n=1,373). Odds Ratios (OR) with 95% confidence intervals (CI) were determined from univariable and multivariable regression analyses.

Results

Elderly patients had a later diabetes diagnosis, a longer diabetes duration, better glucose control and more frequent co-morbid disease conditions. Overall 10.7% of patients experienced any severity hypoglycemia within the last 12 months prior to inclusion. Higher rates of hypoglycemia were observed in the elderly than in the young after adjusting for differences in HbA1c, fasting and post-prandial blood glucose (OR 1.68; 95%CI 1.16-2.45). This was particularly true for hypoglycemic episodes without specific symptoms (OR 1.74; 95%CI 1.05-2.89). In a multivariate model stroke / transitory ischemic attack, the presence of heart failure, clinically relevant depression, sulfonylurea use and blood glucose self-measurement were associated with hypoglycemic events.

Conclusion

Elderly patients are at an increased risk of hypoglycemia even at comparable glycemic control. Therefore identified variables associated with hypoglycemia in the elderly such as heart failure, clinically relevant depression, the use of sulfonylurea help to optimize the balance between glucose control and low levels of hypoglycemia. Asymptomatic hypoglycemia should not be disregarded as irrelevant but considered as a sign of possible hypoglycemia associated autonomic failure.