How common is hypoglycaemia in older people with diabetes who fall?
Research type
Research Study
Full title
How common is hypoglycaemia in older people with diabetes who have falls, dizziness or other symptoms suggestive of hypoglycaemia? A continuous glucose monitoring study
IRAS ID
301266
Contact name
Katharina Mattishent
Contact email
Sponsor organisation
University of East Anglia
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Research Summary
Older people with diabetes often seek treatment in hospital for symptoms such as falls, dizziness or confusion. These symptoms may potentially stem from (undiagnosed) episodes of hypoglycaemia that neither the patient nor the carers / healthcare professionals are aware of.
We regularly attend to patients these symptoms in the Older People’s Emergency Department and Acute Medical Unit. We order tests to find the underlying cause(s) but we currently do not have a good way of testing for recurrent hypoglycaemia in this vulnerable group. The actual reason for the falls and dizzy spells may remain unexplained. Most older patients are likely to have multiple contributing factors to their falls.
For example, we request 24-hour heart monitoring if we suspect a possible problem with the heart. However, we have previously been unable to perform 24-hour glucose monitoring in older people with diabetes to check if low blood sugars are an important contributing factor to their falls and dizzy spells. Use of continuous glucose monitoring (CGM) in research studies has unearthed far more hypoglycaemic episodes than previously thought.
We know that hypoglycaemia in people with diabetes is associated with serious adverse events (cardiovascular events, falls, fractures, death)(5) and that hypoglycaemic episodes are underreported
In England, the National Health Service has prioritized CGM for patients with type 1 diabetes. There is no explicit mention of CGM in older people with type 2 diabetes on medications (insulin,) which carry a high risk of hypoglycaemia.
My project aims to deliver 10 days of CGM to check if hypoglycaemia may be an underlying cause that puts patients at risk of falls, dizziness and confusion. Being able to capture hypoglycaemia will enable a more informed medication review to achieve safer control of diabetes. This may then potentially lead to reduced ED visits, falls and reduce possible risk factors behind cognitive deterioration.
Summary of Results
We recruited 12 participants who had been admitted to hospital for treatment of urgent medical problems. The participants all on daily insulin injections for treatment of their Type 2 Diabetes. One participant withdrew from the study because it was “too much to cope with”.
Of the 11 remaining participants, 5 (45%) did not achieve target for Time Above Range specified in international consensus recommendations. 3/11 spent >15 minutes in hypoglycaemic range, which falls outside of guideline recommendations. There were 6/11 (55%) participants who met the target recommendations for Time in Range.
Serious Adverse Event: One participant was readmitted on Day 5 for medical problems that were not related to diabetes management.
REC name
London - Harrow Research Ethics Committee
REC reference
21/LO/0569
Date of REC Opinion
30 Sep 2021
REC opinion
Further Information Favourable Opinion